Certification and Program Forms

Starting a Program

There are approximately 55 Court Alcohol and Drug Programs within the state. A listing of these Programs is available from the Indiana Office of Court Services. These programs are governed by statute (IC 12-23-14) and by Court Alcohol and Drug Program Rules.

Certification

Court Alcohol and Drug Programs in Indiana are governed by statute (IC 12-23-14) and Judicial Conference Rules. Statutes and rules authorize the Indiana Office of Court Services to establish procedures to certify court alcohol and drug programs.

Client Demographics 

Client Demographics are due March 31, 2020 for the 2019 reporting period. Please complete all applicable forms pertaining to your program. There will be separate links for Felony charges (Part 2) and Misdemeanor charges (Part 3).

Documents and Forms

Document/Form    
Staff Update Form    
Client Demographics - Part 1    
Client Demographics - Part 2 (Felony)    
Client Demographics - Part 3 (Misdemeanor)    

Confidentiality Forms

Document/Form    
Sample Criminal Justice Consent for Release of Information Form Word PDF
Sample General Consent for Release of Information Form Word PDF
Sample Response to Subpoena - Criminal Word PDF
Sample Response to Subpoena - Civil Word PDF
Sample Qualified Service Organization Agreement Word PDF
Sample Prohibition on Re-Disclosure Word PDF

Sample Forms

Document/Form    
Orientation Form Word PDF
Client Rights Form Word PDF
Client Signature Page Word PDF
Assessment Form Word PDF
Individual Service Contract Sample Word PDF
Sample Client Survey Word PDF
Sample Referral Agreement Word PDF