Certification Forms

NOTE: To open, view, and print PDF documents, you need to download the free Adobe Acrobat Reader.  If you do not have Microsoft Word, download Microsoft Viewer. This allows you to open, view, and print Word documents.  To view and print Microsoft PowerPoint presentations, download PowerPoint Viewer.

Adjunctive Medications Forms

Public Disclosure Request Forms

Opiate Treatment Application Forms

New Applicants for Chemical Dependency Service Certification Forms

Currently Certified Chemical Dependency Service Provider Application-type Forms

Annual Re-certification and Fees

Chemical Dependency Professional Trainee (CDP Trainee) SAMPLE Forms

Sample Patient Placement-Type Forms

Other Informational Documents and Forms

Links to:

DSHS Forms Website: http://www1.dshs.wa.gov/msa/forms/index.html

TARGET Forms  http://www1.dshs.wa.gov/DASA/services/target/T2KeForms.shtml

Certification Services page (WACs, RCWs, and other Certification-related topics.)

Certification FAQs and applications.  Frequently asked questions about DASA certification and related application forms.

Directory of Certified Chemical Dependency Services in Washington State

Residential Treatment Agencies that Accept Publicly Funded Patients (PDF).  For details on admission criteria, capacity, insurance types and treatment philosophy.

SAMHSA/CSAT Facility Locator http://dasis3.samhsa.gov/ (National Directory)

Chemical Dependency Professional (CDP) & CDPT program at Department of Health (DOH), Professional Licensing

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