This project is funded under an agreement with the Tennessee Department of Health.

TnPAP Forms

Click on the links below to open a .doc or .pdf version of each form to print

Self Report

Support Group Meeting Attendance

Facilitator Quarterly Report - complete on-line

Progress Evaluation

Meeting Attendance Verification

Work Performance Evaluation

Notification of Name, Address or Employer Change(s)

Application for Support Group Facilitator/Co-Facilitator

Verification of Prescription Medication in PDF Format - requires Adobe Acrobat Reader

TnPAP Monitoring Agreement Overview

Participant General Information

Affinity Online Solutions, Inc. (AOS) Online Reporting Instructions

Affinity Online Solutions, Inc. General Information and Service Options

TnPAP Orientation Instructions

On-line Referral Form

Releases (Exchange of Information To and From . . . )

Therapist or Treatment Providers

Tennessee Department of Health

MD, Pharmacist, or DDS

Employer

Inspector General

Group Facilitators

Evaluator

Miscellaneous
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©2004 Tennessee Professional Assistance Program (TnPAP)
Tennessee Professional Assistance Program (TnPAP)
545 Mainstream Drive, Suite 414, Nashville, TN 37228-1219 USA
Phone: 615.726.4001 Fax: 615.726.4003

The Tennessee Professional Assistance Program does not, for any reason, discriminate against any individual on the grounds of handicap, disability, age, race, color, religion, sex, national origin, or any other classification protected by Federal, State statute constitutional or statutory law.