• Home
  • Resources
  • Self Referrals
  • 3rd Party Referrals
  • Contact
  • Log in

  • Forms
  • Guidelines
  • Other Resources

Downloadable forms you will need to participate in the program.

  • DPHMP Abstinence Acknowledgement
  • DPHMP Addendum to consent employer
  • DPHMP Addendum to consent
  • DPHMP Agreement To Refrain From Practice
  • DPHMP Consent to Services Enrollment Agreement Board Referral
  • DPHMP Consent To Services Enrollment Agreement Vol Referral 0122
  • DPHMP Email Consent
  • DPHMP Medication Management Form
  • DPHMP Monitoring Agreement
  • DPHMP Workplace Contract
  • DPHMP Workplace Monitor Safe Practice Report

All policies governing the DPHMP are contained in the guidelines listed on this page. Enrolled licensees are held accountable to all guidelines. Updates will be posted as changes are made.

  • DPHMP Guideline For Contact With Agreement Monitor
  • DPHMP Guideline For Daily Testing Notification
  • DPHMP Guideline For Dilute And Low Creatinine Specimen Result
  • DPHMP Guideline For ETGETS NonNegative Test Result
  • DPHMP Guideline For Management Of NonNegative Test Results
  • DPHMP Guideline Inclement Weather and Toxicology Testing
  • DPHMP Guideline Medication Assisted Treatment
  • DPHMP Guideline Toxicology Exemption Days
  • DPHMP Medication Management Guideline And Letter
  • DPHMP Over The Counter Meds List 12312019

Resources as well as important program information.

© 2025 - IBH, LLC. All Rights Reserved.