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09997-Addiction Treatment Rpt ( - North Dakota Department of - dot nd

09997-Addiction Treatment Rpt ( - North Dakota Department of - dot nd 2026

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The document is a confidential report from the North Dakota Department of Transportation regarding addiction treatment for drivers. It outlines the process for verifying a patient's completion of an addiction education program, including necessary patient information and consent for the release of treatment details to the Drivers License Division. The report emphasizes confidentiality under federal regulations and specifies distribution requirements for the completed form.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the patient's name, telephone number, and address in the designated fields. Ensure accuracy for proper identification.
Fill in the date of birth, driver's license number, and addiction program/counselor license number as required.
In the 'Verification of Treatment' section, input the dates of enrollment and completion along with the type of treatment received.
The addiction counselor must sign and provide their license number and date in the appropriate fields.
Complete the 'Release of Information' section by certifying your consent for information disclosure. Specify any expiration conditions for this consent.
Finally, ensure all sections are filled out correctly before saving or exporting your completed form for submission.

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Versions	Form popularity	Fillable & printable
2023	4.4 Satisfied (38 Votes)
2022	4.4 Satisfied (48 Votes)
2019	4.2 Satisfied (93 Votes)
2017	4.4 Satisfied (33 Votes)

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Who pays for addiction rehab?

Some forms of financial assistance for substance abuse treatment include: State-funded substance abuse programs and state-funded detox addiction treatment programs. Substance Abuse and Mental Health Services Administration (SAMHSA) grants. Medicare and Medicaid.

How to become a licensed addiction counselor in North Dakota?

A residential treatment center provides intensive, comprehensive assessment and care for individuals dealing with complex mental health and/or addiction issues.

What services does North Dakota Dot provide?

Online services, education and tests, records and suspensions, REAL ID, motorcycles and CDL. Vehicle registrations, history reports, dealer resources, specialty license plates, and more. Information about closures, incidents, construction, and weather conditions.