Properly completed “CONSENT FOR THE RELEASE OF INFORMATION” forms must be returned immediately upon receipt.
A basic medical examination must be performed no more than 6 months prior to admission. (This includes all required lab work. Note: Must attach a copy of the CBC, ALT, Complete UA, RPR, and TB test results received within last year).
Psychosocial History and Evaluation: the assessment must be conducted and dated no more than 6 months prior to admission. If the applicant was treated by a clinician within the past six (6) months, the clinician may submit the Clinical Summary and Discharge Summary but must include an update.
Assessment must support a diagnosis of Alcohol Dependence, Alcohol Abuse or Chemical Dependency per the DSM-V (or its successors) and include diagnosis on Axes I through V.
Copies of Discharge Summaries from previous treatment facilities only if they are within the last year. Please do not send any that are more than 12 months old.