Tennessee Professional Assistance Program How to Report Someone with a Problem
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Communication Authorization (aka Release of Information) Forms

Arch with Water

Addictionologist, Psychiatrist or Pain Management Specialist

Alcohol & Drug Treatment Facility or Mental Health Center

Caduceus Educational Partners, Inc. (aka The Symedica Group) & Affiliates

Employer

Evaluator

Inspector General

Medical Provider

Miscellaneous

Sponsor

Tennessee Department of Health

Therapist/Counselor

 

  
 


Other Forms

Addictionologist, Psychiatrist or Pain Management MD Quarterly Report

Addictionologist or Psychiatrist's Medication Management Quarterly Report

Couple with View

Counselor or Therapist Report

Employer Evaluation

Enrollment Request

Meeting Attendance Verification

Monitoring Completion Survey

Participant General Information

Referral Form

State to State Transfer Form

Verification of Prescribed Medication

 

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

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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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