麻醉治療專案
麻醉治療計劃例外申請
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.
僅適用於州法規的 DHCS 1834 NTP 例外申請表
申請及表格
許可證更新申請-DHCS 4029
臨時治療病人通知- DHCS 4032
麻醉品治療計畫初始申請- DHCS 5014
保證人協議- DHCS 5020
設施和地理區域- DHCS 5025
職員資料- DHCS 5026
縣認證- DHCS 5027
組織責任- DHCS 5031
病人死亡報告- DHCS 5048
附屬和關聯確認- DHCS 5134
協議修訂申請- DHCS 5135
提交所有表格及證明文件至：
醫療保健服務部顧問 & 藥物
輔助治療部，MS2603 郵政信箱 997413 加利福尼亞薩
克拉門托 95899-7413
行動麻醉治療專案
- BHIN 24-005 Mobile Narcotic Treatment Programs (MNTP). This BHIN sets forth the requirements that a MNTP shall comply with lawful implementation and operation in California and establishes an application process for Narcotic Treatment Programs (NTPs) to apply for a MNTP component.
- 流動麻醉治療專案 (MNTP) 工具包
- Mobile Narcotic Treatment Program Initial Application – DHCS 1830
- Application for License Renewal – DHCS 1831
- Application for Protocol Amendment – DHCS 1832
- MNTP 授權網路研討會
麻醉治療專案 執照費
牌照和認證部（LCD）現在將通過自動結算所（ACH）網絡處理的電子貨幣轉賬接受在線付款。希望以電子方式支付費用的提供商可以按照以下鏈接中提供的說明進行操作：https://www.govone.com/PAYCAL/DHCS/Account。