Other Informational Documents and Forms

• ADIS FAQs & ADIS Curriculum Order Form (Washington State)
   
• The Clearinghouse will no longer distribute ASAM manuals at the reduced rate of $65 plus tax once their current supply runs out.  For a limited time only, access their order form at http://clearinghouse.adhl.org/asam.pdf.
   
• Consultants -- List of Private Consultants: 
  Policy and Procedure Development [PDF] or [Word]
  Outcomes Development [PDF] or [Word]
   
• Release of Confidential Information Use this form to request a certified treatment agency to send your records to another party.  This is a Sample fill-in form (HIPAA & 42 CFR Part 2 compliant).  Do not use this form for records held by DSHS.  The requirement that the patient's revocation be in writing was removed from this form per the recommendation of the Legal Action Center www.lac.org.
   
• Patient Record Disposition -- Disposition of patient records accumulated during your agency's period of certification
   
• Multi-Party DOC CJS Release of Confidential Information (Criminal Justice System / Multi-party Authorization for Release of Information, Department of Corrections (DOC) Form #14-029).  This form can be used between DOC, a Mental Health treatment provider, an Alcohol or Drug Treatment Provider, and/or the County-Designated Chemical Dependency Professional.
   
• Client Disclosure Information
   
• DOL's "Assessment/Treatment Report for DASA Certified Agencies" (formerly called the "blue form")
   
• Consumer Complaint Form (Use this form to submit a complaint to DBHR about a certified agency) [Word] (fill-in form) or [PDF] (for printing)
   
• Off-site Certified Chemical Dependency Service Information
   
• Writing Policies, Procedures, and the Program Manual (a discussion paper) [PDF] or [Word]  

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