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Click ‘Get Form’ to open it in the editor.
Begin by entering the child's information in Part I. Fill in the child's name, including first, middle initial, and last name, followed by their social security number.
Proceed to Part II for mental health professional information. Input the clinic name, your name as the mental health professional, and your license or registration number. Select your profession from the options provided.
Indicate whether you are providing services under another individual’s license number by selecting 'Yes' or 'No'. If 'Yes', provide the necessary details.
In the mental health services section, enter the date(s) of service and total hours of service provided. Check all applicable types of services rendered.
Finally, certify your services by signing and dating the form at the bottom.

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What is verification of treatment?

What is a Proof of Drug Treatment Letter? A proof of drug treatment letter is a formal document issued by a licensed treatment center (like Legacy Healing Center) that confirms an individual has enrolled in or completed a substance use rehabilitation program.

What is an example of a treatment verification letter?

I am [title and treating relationship] and am [qualifications/credentials]. [Patient] began treatment here on [date] after being diagnosed with [addiction and mental health issues]. After meeting with [Patient], and considering all appropriate treatment, I prescribed [MAT medication].

What is a letter of verification of treatment?

If you have problems with your mental health (such as depression), you should think about any documents or letters you have from people like: your community psychiatric nurse (CPN) your occupational therapist - for example a care plan. counsellors. a cognitive therapist. social workers.