Forms & Documents > Staff Resources > ROI Consent Forms

Name Description Type Action
DAS-Criminal-Justice-Consent-Pilot Consent form for clients in Court or Probation mandated treatment. File Download
General Consent to Disclose PHI - Drug and Alcohol Services General Consent to Disclose PHI - Drug and Alcohol Services File Download
DSS-815-Form-with-Fax-Cover_1-8-18 Pilot Form 815- Universal Exchange of Protected Information - Updated for 42CFR Part 2 File Download
Joint-Records-Consent-Rev-2 Joint Records Consent - This Document allows Drug and Alcohol Services (DAS) Program Information to be stored in a joint database with other non DAS information. File Download
Probation Department Referral ROI This form can be filled out to allow communication when Probation refers clients to Drug and Alcohol Services. File Download