Tennessee Professional Assistance Program How to Report Someone with a Problem
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  Forms  
  Arch with Water

Exchange of Information To and From (aka Release of Information Forms)

Tennessee Department of Health

Employer

Evaluator

Support Group Manager

Support Group Facilitator

Inspector General

MD, Pharmacist, or DDS

Therapist/Counselor/Treatment Facility/Pain Management Providers

Miscellaneous Release

Sponsor Release

 

  
 


Other Forms

Couple with ViewMeeting Attendance Verification

Monitoring Completion Survey

Participant General Information

Prescribed Medicine Verification

Facilitator Quarterly Report

Enrollment Request

Therapist/Counseling Report

Employer Evaluation

Referral Form

 

  
TnPAP is a program of the Tennessee Nurses Foundation. This program is funded under an agreement with the Tennessee Department of Health.

Home | About Us | Enrollment | Education | Employers | Monitoring | Referral | Forms | Support Groups

Tennessee Professional Assistance Program
545 Mainstream Drive, Suite 414
Nashville, TN  37228-1219
 info@tnpap.org
615-726-4001
FAX 615-726-4003

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