Legislation Documents

Initial Certification

Re-certification Forms

Sample Approval Forms

Mid Term Report

Sample Forms for Certification

Other Documents and Forms

Legislation Documents

Document/Form	MS Word	Adobe PDF
IC 12-23-14	n/a
Indiana Statutes related to Confidentiality and Reporting UPDATED!	n/a
Rules for Court-Adminstered Alcohol and Drug Programs UPDATED!
Checklist for Updating to Current Rules UPDATED!

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Initial Certification

Document/Form	MS Word	Adobe PDF
Five (5) Steps in Starting a Court A & D Program	n/a
Sample Letter - Request for Initial Certification
Initial Certification Application
Sample - Intial Certification Application
Certification Overview and Sample Review Agenda

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Re-certification Forms

Document/Form	Word/Excel	Adobe PDF
Recertification Application & Sample
Sample Review Agenda
Program Policy Procedures Manual Checklist for Certification
Program Practice Checklist for Certification
Certification Review - Tentative Schedule	n/a

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Sample Approval Forms

Document/Form	MS Word	Adobe PDF
Sample Certification Summary UPDATED!	n/a
Sample Final Report UPDATED!	n/a

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Mid Term Report

Document/Form	Word/Excel	Adobe PDF
Sample - Mid-term Status Report UPDATED!
Mid-term Visit Tentative Schedule	n/a

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Sample Forms for Certification

Document/Form	Word/Excel	Adobe PDF
Sample Policy & Procedures Manual
Orientation Form
Client Rights Form
Client Signature Page
Assessment Form
Drug Chart
Sample 1 Individual Service Contract UPDATED!
Sample 2 Individual Service Contract UPDATED!
Client Survey
Sample Progress Notes including Narrative Summary
Sample Referral Agreement
Sample Contract for Services (i.e. education instructor)
Annual Report Outline

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