​​​​​​​​​​​​​​​​​​​​​​​​​Narcotic Treatment Programs

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Narcotic Treatment Program Exception Request

​The NTP Exception Request form is to facilitate the submission of patient exceptions to state regulations California Code of Regulations (CCR), Title 9, Chapter 4 in accordance with Section 10425.  This form is intended for exceptions that only require DHCS state approval and do not require SAMSHA's federal approval.  This does not preclude other forms​ of notifications.  DHCS may grant a temporary exception request in accordance with CCR, Title 9, Section 10425​ for individual licensed NTP locations on a per patient basis.

Patient exception requests to 42 CFR, Part 8, must be submitted through the CSAT portal​ as these are federal laws which require both DHCS and SAMHSA'S approval.  

All approved exception requests must be documented and maintained in the patient's file.

DHCS 1834 NTP Exception Request Form to State Regulations Only​​

Applications ​and Forms

• Application for License Renew​al - DHCS 4029
  
• Narcotic Treatment Program Initial Applicat​ion - DHCS 5014
  
• Guarantor Agreemen​t - DHCS 5020
  
• Facility and Geographical Area - DHCS 5025
  
• Staff Information - DHCS 5026
• County Certification​ - DHCS 5027
  
• Organizational Responsibili​ty​ - DHCS 5031
  
• Patient Death Repor​t - ​​DHCS 5048
  
• Affiliated and Associated ​Acknowledgement - DHCS 5134
  
• Application for Protocol ​Amendment​​ - DHCS 5135
  

• Narcotic Treatment Program Licensure Fees
  

​​Frequently Asked Questions​

• Narcotic Treatment Programs Initial Application
• Medication Unit Application
  

• Office Based Narcotic Treatment Networks Application
  

• ​​​​​​Mobile Narcotic Treatment Program (MNTP) FAQs​​​