--QUARTERLY REPORTS ARE DUE BY 15 January, 15 APRIL, 15
JULY and 15 OCTOBER--
PRINT OUT VERSION- HCMC Account Generation Form (Participant completes)
PRINT OUT VERSION- Signed Acknowledgement Form (Participant completes)
PRINT OUT VERSION- Collection Site Protocols (Participant gives to collection site and collection site completes and returns to HPSP)
PRINT OUT VERSION- Participant Update Form (Participant fills out
quarterly)
ONLINE
FILL-IN VERSION- Participant Update Form- COMING SOON!
PRINT OUT VERSION-Sponsor Form
(Participant give form to sponsor to fill out quarterly)
PRINT OUT VERSION OF Mutual Support Group Attendance (Meeting
Attendance form signed at each meeting)
PRINT
OUT VERSION OF Professionals Group Sponsor Form (Participant have sponsor
sign quarterly)
PRINT
OUT VERSION OF Professionals Group Attendance (Meeting Attendance form
signed at each meeting)
PRINT OUT VERSION-
Work Site Monitor Form ( WSM fills out quarterly)
ONLINE FILL-IN VERSION- Work Site Monitor Form (Online version of form
WSM fills out quarterly)
PRINT OUT VERSION- Treating Professional Form ( Treatment providers
fill out quarterly for the participant)
ONLINE
FILL-IN VERSION- Treating Professional Form (Online version of form
TP fills out quarterly)
PRINT
OUT VERSION- Medication Log (Participant fills out and mails in at the
direction of his/her case manager.)
PRINT
OUT VERSION- Release of Information for Credentialing (Authorization to
Release information)
PRINT
OUT VERSION- Release of Information for Medical Records (Authorization to
Release information)
PRINT
OUT VERSION- Release of Information for Pharmacy Records (Authorization to
Release information)
PRINT
OUT VERSION- Release of Information for Treatment Providers
(Authorization to Release information)
PRINT
OUT VERSION- Release of Information for Work Site Monitors (Authorization to
Release information)
