Participant Resources

Participant Forms

• • Progress Evaluation (PE)

• • Work Performance Evaluation (WPE)

• • Notice of address/employer change 

• • Short Term Medications

• • Medication Management Evaluation

• • Consent to Release Confidential Information to Third Party

• • Consent to Release Confidential Information for Facilitator/Co-Facilitator

• • Consent to Release Confidential Information for Individual Therapy

• • Consent to Release Confidential Information for Employer

• Consent to Release Confidential Information to Alternative Program

Links

• • IPN Participant Orientation Course

• • Frequently Asked Questions

January 2020

Post Test 33—Connecting the Dots

Objectives:

1. To examine the relationship between alcohol/drug use and life consequences

You must score a 70% or above on the post test to receive a continuing education credit via-Cebroker.com.