HPMP Reporting Forms

Monthly Reporting Forms

• Participant Progress Report
• Group Attendance
• Treatment Report Monthly
• Authorization for the Release of Confidential Information
• Psychiatrist Report Monthly
• Physician Report Monthly
• Work Site Monitor Report
• Work Site Monitor Report - Pharmacists only
• Peer Monitor Report
• Employer Report
• Witnessed Medication - Antabuse
• Witnessed Medication - Naltrexone
• Witnessed Medication - Vivitrol

Quarterly Reporting Forms

• Treatment Report Quarterly
• Psychiatrist Report Quarterly

PRN Reporting Forms

• Physician Report - PRN

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