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DASA CONTRACTUAL POLICY MANUAL - Illinois Department of

DASA CONTRACTUAL POLICY MANUAL - Illinois Department of 2026

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The document is a licensing and certification form for medical directors or physicians involved in alcoholism and substance abuse treatment. It collects personal information, professional registration details, and inquiries about previous associations with similar programs, felony convictions, and compliance with relevant regulations.

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Click ‘Get Form’ to open the DASA CONTRACTUAL POLICY MANUAL in the editor.
Begin by entering the Facility Name and your Name in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in your Sex, Social Security Number, Position, Date of Birth, Place of Birth, and Residence Address. Double-check these details for correctness.
Provide your City, State, Zip Code, and Telephone Number. This information helps maintain communication regarding your application.
Enter your Professional Registration Numbers and indicate if your registration is in good standing by selecting 'Yes' or 'No'.
Complete the sections regarding previous professional practices and any associations with alcoholism and substance abuse programs.
Answer the questions about felony convictions and federal registrations honestly. Your responses are vital for compliance.
Finally, confirm you have read the Department of Human Services Rule Part 2060 by selecting 'Yes' or 'No', then provide your signature and date.

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What is the meaning of supr?

WordReference Random House Unabridged Dictionary of American English 2024. supr., superior. supreme.

What is the purpose of the Supr?

SUPRs system of care involves screening, assessment, referral, intervention, and treatment for individuals with a substance use disorder, those in recovery, and those who are at-risk.

How do you spell supr?

Supr. Merriam-Webster.com Dictionary, Merriam-Webster, .

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What is supr?

Substance Use Prevention Recovery (SUPR) Provider Information.

DASA CONTRACTUAL POLICY MANUAL - Illinois Department of 2026

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