Release of Information Forms

A signed Release of Information (ROI) Consent Form for all of your providers must be on file with PAS. Completed consent forms may be faxed to (720) 213-1007.

Program Participant Forms

Contact Change Form

Medical Time Off Request Form

Pre-Employment Checklist

Provider Verification Form

Relapse Prevention Plan Form

Relapse Prevention Plan Form – Advanced

Talbott Medication Guide for Safe Recovery

Travel Request Form

Urine Screening Standards – Client

Rehabilitation Contract Reports

Rehabilitation Contract reports are due on the 4th of the month.
(Reports for the January reporting period are due February 4th.)

Fax reports to: 720.213.1007 (Last Name A – L) or 720.213.0002 (Last Name M – Z)

Email reports to: reports@peerassist.org

Notice to clients: Standard email is an unsecured method of correspondence; therefore reports submitted via this method may be at risk for interception. PAS uses ZixCorp encryption for all email communication with clients.

Participants may choose one of the four Self-Status Reports to submit each reporting period, it is not necessary to submit all four versions.

Addictionologist Report

Annual History & Physical

Meeting Verification

Group Meeting Verification

Opiate Replacement Therapy Report

Pain Management Provider Report

PDMP Record Request – Email Receipt

Dental Practice Monitor Report

Mental Health Professional Practice Monitor Report

Nursing Practice Monitor Report

Veterinarian Practice Monitor Report