Wyoming STATE BOARD OF NURSING

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Wyoming STATE BOARD OF NURSING"

Transcription

1 Matthew H Mead Governor Wyoming STATE BOARD OF NURSING Mary Kay Goetter, PhD, RNC, NEA-BC Executive Director 1810 Pioneer Avenue Cheyenne, Wyoming Phone: FAX: MONITORING CONTRACT 1. This contract is a legally binding written agreement between the Wyoming State Board of Nursing (WSBN) Nurse Monitoring Program (NMP) and (nurse) detailing what is expected of you while being monitored. 2. You will be held accountable for all terms and conditions of this contract. 3. You are required to sign the monitoring agreement upon entering the program. a. This is a monitoring contract as a result of a Board order or an open complaint for a substance use issue. b. The program records are non-public and have necessary exceptions for disclosure, such as to Board of Nursing members, other State Boards and other states alternative programs regarding the participants in the Nurse Monitoring Program (NMP). c. You are required to have work site monitoring upon return to work. d. The consequences of relapse and noncompliance with the monitoring contract will result in notification to the Disciplinary Committee for possible further disciplinary action against your license. e. Relapse is defined as any unauthorized use or abuse of alcohol, medications, or mind-altering substances. f. You are required to sign a document acknowledging receipt and understanding of the NMP policies and procedures handbook. g. The period of monitoring will be months, per your WSBN Settlement Agreement Contract. Conditions may be gradually decreased after a minimum of one (1) year of full compliance and/or evidence of other recovery parameters. If you are not fully compliant, your contract conditions may be increased. 4. The terms and conditions set forth in this contract are as follows. You shall: a. Abstain from all alcohol and alcohol-containing products without prior approval from the NMP. b. Abstain from drug use including all over-the-counter medications and other mindaltering substances unless lawfully prescribed and with prior approval of the NMP. c. Maintain current Wyoming nursing licensure. d. Sign release forms necessary for monitoring and consents to exchange information between: i. Employer and NMP; ii. Healthcare providers and NMP; iii. Treatment professionals and NMP; iv. Medical Review Officer and NMP; v. Other state boards and alternative programs and NMP.

2 e. Complete substance abuse/dependency evaluations and/or mental health assessment, treatment, continuing care, and aftercare at your own expense. f. Enter treatment and participate in all treatment recommendations at your own expense. g. Submit a progress report from your treatment provider or counselor to the NMP monthly or as directed by your WSBN Settlement Agreement. h. Notify NMP of co-occurring conditions, e.g., psychiatric or medical diagnoses. i. Obtain an assessment by a physician who is approved by the NMP and has a subspecialty in addictions and pain management as required by your individual treatment plan. j. Sign and adhere to pain management contract if you have a diagnosis of chronic pain as well as Substance Use Disorder. k. Undergo any additional evaluation as requested by the NMP or treatment provider. l. Attend a minimum of three (3) 12-step meetings/week and one(1) peer support group/week and submit monthly documentation to the NMP. m. Maintain an active and consistent relationship with a sponsor. n. Report within twenty-four (24) hours to the NMP any prescriptions for moodaltering drugs as well as over-the-counter medications. o. Provide the NMP the contact information for the following: 1. One (1) pharmacy for prescription needs; 2. One (1) healthcare provider for healthcare needs; 3. One (1) dentist for dental needs. p. Notify the NMP if a prescription is received and provide verification for any medications within twenty four (24) hours of receipt of prescription or medication and prior to returning to nursing practice. q. Notify any and all health care providers of Substance Use Disorder history prior to receiving any prescription. r. Provide a written statement from the prescribing provider that confirms the provider s awareness of your history of Substance Use Disorder. s. Assure that your chosen health and dental care practitioners complete medication verification forms and medication logs provided by the program and submit quarterly by the 10 th of the month following the quarter. Forms will be due March, June, September and December. t. Provide written self-reports monthly by the 10 th of the following month. u. Maintain continuous employment in a nursing position for at least one(1) year of the three (3) to five(5) year contract or as dictated by your Settlement Agreement, in order to be eligible for successful discharge from the program. v. Practice nursing in one state only. Permission to work in any other state requires prior written approval from the Disciplinary Committee and the Board of Nursing in the other state. w. If licensed in another state or seeking licensure in another state, NMP will release participant information to any other state of licensure where you are applying for licensure. x. Notify and obtain approval from the NMP for any healthcare related position or job change before making the change or relocating. y. Abide by return to work restrictions and requirements.

3 z. Inform any prospective or current nursing position employers or nursing schools of your participation in the NMP and provide copy of contract, stipulations and/or final orders from the WSBN. aa. Ensure your supervisor has received a copy of the contract and any other necessary forms. bb. Ensure that the NMP receives the agreement form signed by the direct supervisor before beginning a new or resuming an existing position. cc. Notify within two (2) days the NMP of any change in your supervisor, workplace monitor, or employment. dd. Abide by all policies, procedures, and contracts of employer. ee. Schedule at least monthly check-in meetings with supervisor for the purpose of addressing any concerns of either party. The documentation of the meetings shall be available to the NMP staff if requested. ff. Obtain approval by NMP before any position acceptance, job responsibility change, or other related employment activity. gg. Discontinue access to and administration of controlled substances or any potentially addictive medications for months after returning to work as outlined in your WSBN Settlement Agreement. You will not be allowed to sign out, witness, administer or call in prescriptions for controlled substances. hh. Notify the NMP within two (2) days if you had a disciplinary meeting or employment counseling with employer. ii. Notify the NMP within two (2) days of any changes in residency, contact information, and for any termination or resignation from employment jj. Report within twenty-four (24) hours any crimes committed, criminal arrests, citations, or deferred sentences, and convictions, including a conviction following a plea of nolo contendere. kk. Notify program if a complaint is filed against your license. ll. Report any and all alcohol or drug relapses, regardless of amount or route of administration. mm. Agree to re-assessment by a licensed addiction counselor in the event of relapse. nn. Abide by further recommendations in the event of a relapse, as deemed clinically appropriate. oo. Pay all fees and costs associated with being in the NMP. This includes, but is not limited to, all medical, counseling, prescription and drug screenings. You will also incur the cost of the Medical Review Officer to review positive drug test results to ensure medications are taken as prescribed. pp. Agree to read and abide by the terms and conditions of the program handbook or manual as well as any new policies or procedures received in writing throughout participation in the NMP. qq. Appear in person for all routinely scheduled interviews and any additional interviews with reasonable notice given by the NMP. rr. Inform the NMP verbally and in writing of a pending relocation out of the state. 5. In signing the contract, you agree that you understand the following: a. You have a substance use disorder.

4 b. Any noncompliance with this contract or unsuccessful termination from the program is unprofessional conduct, is in violation of the rules and laws regarding the practice of nursing, and will be used to support any future progressive disciplinary actions. c. Entry into the NMP is a result of a WSBN Board order for discipline or an open complaint for a substance use issue; there was an opportunity to seek advice of legal counsel or personal representative, and there was opportunity to clarify any terms or conditions which were not understood. d. The terms of the contract may be shared with parties who have an official need to know, such as other state boards, other state s alternative programs, and participant s employers. e. The contract does not preclude the program from initiating and/or taking appropriate action regarding any other misconduct not covered by the contract. Such action will result in notifying the DC. f. If you violate any single part, or parts, of the contract, the remaining parts remain valid and operative. g. Any unauthorized missed drug or alcohol testing will be considered noncompliance with the NMP and notification to the DC. h. Any confirmed positive drug screen may be considered noncompliance if the NMP has not received the proper documentation from the prescribing practitioner and will result in notification of the DC. i. Any drug screen that is confirmed as an adulterated or substituted specimen shall result in notification to the DC. j. Noncompliance with drug and alcohol testing will result in an increased level of testing and will result in a notification to the DC. k. In the event of any non-compliance with any of the terms of the contract in any respect, the NMP will notify the DC and the length and terms of this contract may be extended and modified as per the DC s recommendations. l. The DC will be notified of any non-compliance with the terms of the contract. m. You are required to provide a supervisor with a copy of the contract and any other necessary forms before beginning a new or resuming an existing position and agree to notify the program immediately of any change in supervision. Failure to comply will result in a notification of the DC for possible further disciplinary action. n. Random drug screening will be performed two (2) to three (3) times/month or as recommended by your mental health provider. After the first year, there may be a gradual decrease in the frequency of random drug screens for the duration of the contract depending upon compliance and recovery status. o. Drug and alcohol testing will be random. p. Drug and alcohol testing can be requested for cause at any time and within any timeframe. q. Drug testing will be observed. r. The DC will be notified of any report of substituting, diluting or adulterating specimens. s. A strict chain of custody will be followed (observed collection, specimen sealed and signed by participant nurse, collector and lab).

5 t. When indicated, a blood alcohol test or breathalyzer may be done as well as a urine drug screen. u. When indicated, a hair (from any area of the body) analysis drug test may be done in conjunction with urine tests. Hair testing will not be the sole means of testing. Drug and alcohol testing may include body fluid, hair, saliva or any other valid and reliable method of testing. v. You are responsible for payment of charges for the drug and alcohol testing. w. You are required to submit to drug and alcohol testing on the same business day or within two (2) hours for cause drug screen. x. Your Work Site Monitor must be your supervisor and/or licensed to practice nursing with at least your level of credentials (i.e. an LPN may not be a worksite monitor for an RN), whose license is unencumbered and is not a current participant in any alternative program. y. You are required to submit Self-reports to the NMP monthly. z. You are required to have periodic one-on-one visits with worksite monitor and/or supervisor. aa. During the first twelve (12) months of participation in the program you are restricted from working any of the following (or as designated by your Settlement Agreement): 1. Odd schedules-overtime, night shift, anything in excess of a twelve (12) hour shift. 2. No more than three consecutive 12-hour shifts. 3. Without direct supervision. 4. Full access to controlled substances. 5. Home Health or Hospice-type settings, travel, registry/agency, float or on-call (PRN) pool, tele-nursing and disaster relief nursing. 6. Any other unsupervised nursing position. bb. The WSBN NMP will obtain your prescription drug profile quarterly. cc. If relapse, diversion, or other violations of the work-related requirements occur, the NMP will notify the employer and generate a complaint to the Disciplinary Committee. dd. The NMP will continue to monitor you even after being referred to the Disciplinary Committee. ee. Any relapse is considered noncompliance and will result in a complaint to the Disciplinary Committee. Other conditions for monitoring as per your WSBN Settlement Agreement:

6 I have read, understand and agree to the terms of this monitoring agreement. Name (Printed) Date Signature

Agenda Item # 7.1.4 Prepared by: Katherine Thomas and Michael Van Doren Board Meeting Date: January 27-28, 2011

Agenda Item # 7.1.4 Prepared by: Katherine Thomas and Michael Van Doren Board Meeting Date: January 27-28, 2011 Agenda Item # 7.1.4 Prepared by: Katherine Thomas and Michael Van Doren Board Meeting Date: January 27-28, 2011 Comparison of NCSBN Guidelines for Alternative Programs and Discipline Monitoring Programs

More information

SIGNATURES & DATED COPY ON FILE IN BOARD OFFICE

SIGNATURES & DATED COPY ON FILE IN BOARD OFFICE In the Matter of Jennifer Ramberg, CNA BEFORE THE OREGON STATE BOARD OF NURSING ) STIPULATED ORDER FOR ) PROBATION Certificate No. 200212542CNA ) Reference No. 15-00992 Jennifer Ramberg (CNA) was issued

More information

TAPNET RETURN TO WORK AGREEMENT

TAPNET RETURN TO WORK AGREEMENT TAPNET RETURN TO WORK AGREEMENT selor Participant s name License # Case Manager Ext Type of Participation: Substance Use Disorder Psychiatric Disorder Dual Diagnosis RETURN TO WORK CONFERENCE APPROVED

More information

NORTH CAROLINA BOARD OF NURSING INTERVENTION PROGRAM (IP) CONTRACT

NORTH CAROLINA BOARD OF NURSING INTERVENTION PROGRAM (IP) CONTRACT NORTH CAROLINA BOARD OF NURSING INTERVENTION PROGRAM (IP) CONTRACT This Contract is made and executed by and between the licensed registered or practical nurse (the Licensee ) identified below, and the

More information

PARTICIPANT ORIENTATION COURSE

PARTICIPANT ORIENTATION COURSE a monitoring and recovery program for nurses PARTICIPANT ORIENTATION COURSE C R E AT E D B Y R O B I N A. L E W I S, E d D, M S N, F N P - B C, R N R E V I S E D B Y S A N D R A H U D S O N, R N, B S N,

More information

3.1. The procedure shall be applicable to all University employees.

3.1. The procedure shall be applicable to all University employees. LINCOLN UNIVERSITY Procedure: Confirmatory Testing for Substance Abuse Procedure Number: HRM 113p Effective Date: October 2008 Revisions: Review Officer: Chief Human Resources Officer 1. Purpose 1.1. It

More information

MONITORING AGREEMENT Overview

MONITORING AGREEMENT Overview MONITORING AGREEMENT Overview Voluntarily agree to participate in the Tennessee Professional Assistance Program (TnPAP) and adhere to the terms set forth in the Monitoring Agreement. Abstinence from Drugs

More information

Resource for Nurse Administrators. Employing Nurses Participating in Drug. Monitoring Programs. With. The North Carolina Board of Nursing (NCBON)

Resource for Nurse Administrators. Employing Nurses Participating in Drug. Monitoring Programs. With. The North Carolina Board of Nursing (NCBON) Resource for Nurse Administrators Employing Nurses Participating in Drug Monitoring Programs With The North Carolina Board of Nursing (NCBON) Participant Name: Program : Monitoring Coordinator: Phone:

More information

HACH COMPANY DRUG AND ALCOHOL POLICY

HACH COMPANY DRUG AND ALCOHOL POLICY HACH COMPANY DRUG AND ALCOHOL POLICY I. Purpose Hach Company is committed to a safe, healthy, and productive work environment for all Associates free from the effects of substance abuse. Abuse of alcohol,

More information

3793:2-1-08 Treatment services.

3793:2-1-08 Treatment services. Attachment 1 Ohio Administrative Code» 3793:2 Program Standards» Chapter 3793:2-1 Alcohol and Drug Addiction Programs 3793:2-1-08 Treatment services. (A) The purpose of this rule is to define alcohol and

More information

POLICY FOR A DRUG AND ALCOHOL-FREE WORKPLACE

POLICY FOR A DRUG AND ALCOHOL-FREE WORKPLACE POLICY FOR A DRUG AND ALCOHOL-FREE WORKPLACE I. STATEMENT OF PURPOSE Crossroads of Western Iowa recognizes the problems of substance abuse in society and in the workplace. Substance abuse poses a serious

More information

A Guideline for California From California Public Protection and Physician Health, Inc.

A Guideline for California From California Public Protection and Physician Health, Inc. MAKING INFORMED CHOICES: Guidelines for Selecting Physician Health Services A Guideline for California From California Public Protection and Physician Health, Inc. CONTENTS INTRODUCTION 2 HOW PHYSICIAN

More information

SERVING GRANITE CITY, MITCHELL, AND PONTOON BEACH

SERVING GRANITE CITY, MITCHELL, AND PONTOON BEACH 2001 Delmar Avenue Granite City, IL 62040-6238 618-452-6238 smrld.org Tina Hubert Executive Director SERVING GRANITE CITY, MITCHELL, AND PONTOON BEACH SMRLD Drug and Alcohol Free Workplace Policy Purpose

More information

KENTUCKY ALTERNATIVE RECOVERY EFFORT ( KARE )

KENTUCKY ALTERNATIVE RECOVERY EFFORT ( KARE ) KENTUCKY ALTERNATIVE RECOVERY EFFORT ( KARE ) PARTICIPANT HANDBOOK 312 Whittington Parkway, Ste 300 Louisville, Kentucky 40222 (800) 305-2042 FAX (502) 429-3353 Table of Contents Introduction... 3 Monitoring

More information

Substance Abuse Program

Substance Abuse Program Substance Abuse Program www.tridentinsurance.net Lines of Business: Auto, Worker Compensation, Public Officials Liability, Educators Legal Liability, General Liability Risk Control Strategy/Key Issues:

More information

Policies & Procedures

Policies & Procedures 2.2 Drug Free Work Place Adopted 1.24.2003 Revised 3.28.2004; 5.26.2006; 3.2.2011 Reference: WAC 388.805.200(3) POLICY In accordance with "The Drug Free Workplace Act of 1988, The Healing Lodge prohibits

More information

X. SUBSTANCE ABUSE/DRUG-FREE WORKPLACE POLICY

X. SUBSTANCE ABUSE/DRUG-FREE WORKPLACE POLICY X. SUBSTANCE ABUSE/DRUG-FREE WORKPLACE POLICY GENERAL POLICY It is the policy of Scott County to provide safe, dependable and efficient services to the public which it serves. Scott County is committed

More information

PIERCE COUNTY DRUG COURT PARTICIPANT HANDBOOK. Last updated 09.01.13

PIERCE COUNTY DRUG COURT PARTICIPANT HANDBOOK. Last updated 09.01.13 PIERCE COUNTY DRUG COURT PARTICIPANT HANDBOOK 0 WELCOME The Drug Court is an intervention program for adults who have pled guilty to a crime related to their drug or alcohol addiction. It is a cooperative

More information

State Recommended Drug Free Workplace Policy

State Recommended Drug Free Workplace Policy INSTRUCTIONS: State Recommended Drug Free Workplace Policy The following policy should have the first page printed on company letterhead. The sections which are in italics are to be removed. They are for

More information

This is a Legal Document. By completing and signing this, you certify under

This is a Legal Document. By completing and signing this, you certify under APPLICATION FOR WYOMING REGISTERED NURSE (RN) or LICENSED PRACTICAL NURSE (LPN) By EXAMINATION *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this,

More information

Mandatory Drug Testing Student Drug Testing Policy Cabot Public Schools

Mandatory Drug Testing Student Drug Testing Policy Cabot Public Schools Mandatory Drug Testing Student Drug Testing Policy Cabot Public Schools MISSION STATEMENT: Cabot Public Schools recognizes that drug abuse is a significant health problem for students, detrimentally effecting

More information

Section 303(g)(2)(G) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)) is amended. (1) by striking clause (ii) and inserting the following:

Section 303(g)(2)(G) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)) is amended. (1) by striking clause (ii) and inserting the following: Section XX. Definitions. Section 303(g)(2)(G) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)) is amended (1) by striking clause (ii) and inserting the following: (ii) The term qualifying practitioner

More information

CRAIG HOSPITAL POLICY/PROCEDURE Approved: P&P 01/05; 04/08; 03/12 Effective Date: 11/89

CRAIG HOSPITAL POLICY/PROCEDURE Approved: P&P 01/05; 04/08; 03/12 Effective Date: 11/89 CRAIG HOSPITAL POLICY/PROCEDURE Approved: P&P 01/05; 04/08; 03/12 Effective Date: 11/89 HR 43 Attachments: None Revised Date: 04/02, 09/04, 01/05, 04/08, 03/12 Forms: None Reviewed Date: SUBJECT: DRUG

More information

MONTANA PROFESSIONAL ASSISTANCE PROGRAM, INC. POSITION DESCRIPTION:

MONTANA PROFESSIONAL ASSISTANCE PROGRAM, INC. POSITION DESCRIPTION: MONTANA PROFESSIONAL ASSISTANCE PROGRAM, INC. POSITION DESCRIPTION POSITION DESCRIPTION: REPORTS TO: CLINICAL COORDINATOR CLINICAL DIRECTOR SUPERVISES: SUMMARIES OF DUTIES Reports to the Clinical Director.

More information

CAMPUS DRUG AND ALCOHOL POLICY FOR UNIVERSITY EMPLOYEES

CAMPUS DRUG AND ALCOHOL POLICY FOR UNIVERSITY EMPLOYEES CAMPUS DRUG AND ALCOHOL POLICY FOR UNIVERSITY EMPLOYEES TABLE OF CONTENTS I. STATEMENT OF POLICY...1 II. DISCIPLINE...2 III. SEEKING HELP...2 IV. DRUG TESTING PROGRAM FOR EMPLOYEES OF THE UNIVERSITY...2

More information

ASSERTIVE COMMUNITY TREATMENT TEAMS

ASSERTIVE COMMUNITY TREATMENT TEAMS ARTICLE 11. ASSERTIVE COMMUNITY TREATMENT TEAMS Rule 1. Definitions 440 IAC 11-1-1 Applicability Sec. 1. The definitions in this rule apply throughout this article. (Division of Mental Health and Addiction;

More information

Driver DOT Drug Free Guidelines Mackay School District #182

Driver DOT Drug Free Guidelines Mackay School District #182 Driver DOT Drug Free Guidelines Mackay School District #182 In recognition of the harmful effects that the use of illegal drugs and the misuse of the alcohol can have on drivers engaged in the transportation

More information

UNCONTROLLED. Title: Drug and Alcohol Abuse Testing and Rehabilitation

UNCONTROLLED. Title: Drug and Alcohol Abuse Testing and Rehabilitation 1.0 Purpose and Scope Waupaca Foundry, Inc. ( Company ) values its employees and recognizes their need for a safe and healthy work environment. Waupaca Foundry, Inc. also recognizes that employees abusing

More information

MIDWESTERN UNIVERSITY DRUG FREE WORKPLACE AND SUBSTANCE ABUSE POLICY

MIDWESTERN UNIVERSITY DRUG FREE WORKPLACE AND SUBSTANCE ABUSE POLICY MIDWESTERN UNIVERSITY DRUG FREE WORKPLACE AND SUBSTANCE ABUSE POLICY PURPOSE: POLICY: I. To establish policies and procedures whereby Midwestern University shall, in order to appropriately serve the needs

More information

CITY OF ESSEXVILLE SUBSTANCE ABUSE POLICY

CITY OF ESSEXVILLE SUBSTANCE ABUSE POLICY CITY OF ESSEXVILLE SUBSTANCE ABUSE POLICY Department of Transportation Regulated Employees (Original Adoption November 29, 1995, Latest Revision November 17, 2008) I. PURPOSE The City of Essexville ( Employer

More information

EXHIBIT A. GRIEVANCE FORM (use additional sheets where necessary) STEP ONE EMPLOYER S STEP ONE RESPONSE STEP TWO

EXHIBIT A. GRIEVANCE FORM (use additional sheets where necessary) STEP ONE EMPLOYER S STEP ONE RESPONSE STEP TWO EXHIBIT A GRIEVANCE FORM (use additional sheets where necessary) Filed: Department: Village of Freeburg Public Works Grievant s Name: Last First M.I. STEP ONE of Incident or Knew of Facts Giving Rise to

More information

THE COLLEGE OF WESTERN IDAHO PTE PROGRAMS DRUG FREE SCHOOL POLICY

THE COLLEGE OF WESTERN IDAHO PTE PROGRAMS DRUG FREE SCHOOL POLICY THE COLLEGE OF WESTERN IDAHO PTE PROGRAMS DRUG FREE SCHOOL POLICY Policy Statement The College of Western Idaho s PTE Programs has an interest in establishing an environment free of the influence of drugs

More information

Sixty-third Legislative Assembly of North Dakota In Regular Session Commencing Tuesday, January 8, 2013

Sixty-third Legislative Assembly of North Dakota In Regular Session Commencing Tuesday, January 8, 2013 Sixty-third Legislative Assembly of North Dakota In Regular Session Commencing Tuesday, January 8, 2013 HOUSE BILL NO. 1091 (Human Services Committee) (At the request of the State Board of Nursing) AN

More information

This is a Legal Document. By completing and signing this, you certify under

This is a Legal Document. By completing and signing this, you certify under APPLICATION FOR WYOMING REGISTERED NURSE LICENSURE with APRN RECOGNITION All licenses expire December 31 of every EVEN year This is a Legal Document. By completing and signing this, you certify under penalty

More information

FEDERAL HEIGHTS POLICE DEPARTMENT

FEDERAL HEIGHTS POLICE DEPARTMENT FEDERAL HEIGHTS POLICE DEPARTMENT Effective Date: May 1999 Directive: 171.5 Approved By: Chief Acker (City of Federal Heights Personnel Code) Employee Drug or Alcohol Abuse Section XII. - Drugs and Alcohol.

More information

DRUG AND ALCOHOL FREE WORKPLACE POLICY (Article 24 of the Crow Wing County Personnel Manual)

DRUG AND ALCOHOL FREE WORKPLACE POLICY (Article 24 of the Crow Wing County Personnel Manual) DRUG AND ALCOHOL FREE WORKPLACE POLICY (Article 24 of the Crow Wing County Personnel Manual) ARTICLE 24: DRUG AND ALCOHOL FREE WORKPLACE POLICY 24.00 Policy Crow Wing County is committed to protecting

More information

IMPLEMENTATION SUGGESTIONS

IMPLEMENTATION SUGGESTIONS PLEASE NOTE! Please be aware that the Sample Drug and Alcohol Policy is being furnished to you as a courtesy and the language therein should be considered that of a sample. Because the Drug and Alcohol

More information

This is a Legal Document. By completing and signing, this you certify under

This is a Legal Document. By completing and signing, this you certify under APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) BY ENDORSEMENT, or DEEMING *All certificates expire December 31 of every EVEN year* This is a Legal Document. By completing and signing, this

More information

17 th Judicial District Treatment Court. Participant Handbook

17 th Judicial District Treatment Court. Participant Handbook 17 th Judicial District Treatment Court Participant Handbook Name: Date Issued: Case Manager: Case Manager Phone: Probation Officer: Probation Officer Phone: Counselor Name: Counselor Phone: CHARACTER

More information

Health, Safety, Environment and Community. Management System. Drug and Alcohol PETROLEUM CSG HSEC MANAGEMENT SYSTEM PROCEDURE DRUG AND ALCOHOL

Health, Safety, Environment and Community. Management System. Drug and Alcohol PETROLEUM CSG HSEC MANAGEMENT SYSTEM PROCEDURE DRUG AND ALCOHOL PETROLEUM CSG HSEC MANAGEMENT SYSTEM PROCEDURE DRUG AND ALCOHOL Petroleum HSEC Procedure No: Date: May 21, 2014 Revision: 4.1 Owner: Kim Phillips, Occupational Health and Hygiene Manager Approver: David

More information

CHARTER OF THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF RITE AID CORPORATION

CHARTER OF THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF RITE AID CORPORATION CHARTER OF THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF RITE AID CORPORATION 1. Purpose. The purpose of the Audit Committee of the Board of Directors of Rite Aid Corporation (the Corporation ) is to:

More information

CITY OF CRIPPLE CREEK DRUG AND ALCOHOL TESTING POLICY AND PROCEDURE MANUAL

CITY OF CRIPPLE CREEK DRUG AND ALCOHOL TESTING POLICY AND PROCEDURE MANUAL CITY OF CRIPPLE CREEK DRUG AND ALCOHOL TESTING POLICY AND PROCEDURE MANUAL I. Purpose The City of Cripple Creek is committed to a safe, healthy, and productive work environment for all employees free from

More information

Policy ALCOHOL AND DRUG BRI-HS-PI-00002

Policy ALCOHOL AND DRUG BRI-HS-PI-00002 Policy ALCOHOL AND DRUG Effective: November 21, 2014 1. Policy Statement As a responsible employer, Brion Energy Corporation ( Brion or the Company ) has an interest in establishing programs to promote

More information

Quality Management. Substance Abuse Outpatient Care Services Service Delivery Model. Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA)

Quality Management. Substance Abuse Outpatient Care Services Service Delivery Model. Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) Quality Management Substance Abuse Outpatient Care Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White

More information

RULES OF DEPARTMENT OF HEALTH DIVISION OF PAIN MANAGEMENT CLINICS CHAPTER 1200-34-01 PAIN MANAGEMENT CLINICS TABLE OF CONTENTS

RULES OF DEPARTMENT OF HEALTH DIVISION OF PAIN MANAGEMENT CLINICS CHAPTER 1200-34-01 PAIN MANAGEMENT CLINICS TABLE OF CONTENTS RULES OF DEPARTMENT OF HEALTH DIVISION OF PAIN MANAGEMENT CLINICS CHAPTER 1200-34-01 PAIN MANAGEMENT CLINICS TABLE OF CONTENTS 1200-34-01-.01 Purpose 1200-34-01-.06 Notifications 1200-34-01-.02 Definitions

More information

Assembly Bill No. 85 Committee on Commerce and Labor

Assembly Bill No. 85 Committee on Commerce and Labor Assembly Bill No. 85 Committee on Commerce and Labor CHAPTER... AN ACT relating to professions; transferring certain duties of the Secretary-Treasurer of the Board of Examiners for Alcohol, Drug and Gambling

More information

R156. Commerce, Occupational and Professional Licensing. R156-67. Utah Medical Practice Act Rule. R156-67-101. Title. R156-67-102. Definitions.

R156. Commerce, Occupational and Professional Licensing. R156-67. Utah Medical Practice Act Rule. R156-67-101. Title. R156-67-102. Definitions. R156. Commerce, Occupational and Professional Licensing. R156-67. Utah Medical Practice Act Rule. R156-67-101. Title. This rule shall be known as the "Utah Medical Practice Act Rule". R156-67-102. Definitions.

More information

Policy Number 13.8. Date Filed. Subject

Policy Number 13.8. Date Filed. Subject Total s 501 KAR 6:020 KENTUCKY CORRECTIONS Policies and Procedures Date Filed 10 References/Authority KRS 196.035, 197.020, 202A.400, 218A, 241.010, 319.005 908 KAR 1:370 ACA 4-4377, 4-4396, 4-4433, 4-4437,

More information

RAMP. Recovery & Monitoring Program

RAMP. Recovery & Monitoring Program RAMP Recovery & Monitoring Program Participant Guide Recovery & Monitoring Program A Program of the Institute for Nursing 1479 Pennington Road Trenton New Jersey 08618 Table of Contents Introduction..

More information

JFK MEDICAL CENTER. MANUAL: Administrative Policy & Procedure Manual. SECTION: Human Resources. DISTRIBUTION: All Departments

JFK MEDICAL CENTER. MANUAL: Administrative Policy & Procedure Manual. SECTION: Human Resources. DISTRIBUTION: All Departments 1 MANUAL: Administrative Policy & Procedure Manual SECTION: Human Resources DISTRIBUTION: All Departments SUBJECT: Substance Use in the Workplace EFFECTIVE DATE: 12/06 REVIEWED DATE: 09/07 REVISED DATE:

More information

DEPARTMENT OF HUMAN RESOURCE MANAGEMENT POLICY NO.: 1.05 POLICIES AND PROCEDURES MANUAL EFFT. DATE: 9-16-93 UPDATED: 3-2004 ALCOHOL AND OTHER DRUGS

DEPARTMENT OF HUMAN RESOURCE MANAGEMENT POLICY NO.: 1.05 POLICIES AND PROCEDURES MANUAL EFFT. DATE: 9-16-93 UPDATED: 3-2004 ALCOHOL AND OTHER DRUGS OBJECTIVE It is the Commonwealth's objective to establish and maintain a work environment free from the adverse effects of alcohol and other drugs. The effects of alcohol and other drugs in the workplace

More information

CHAPTER 2010-211. Committee Substitute for Committee Substitute for Senate Bill No. 2272 and Committee Substitute for Senate Bill No.

CHAPTER 2010-211. Committee Substitute for Committee Substitute for Senate Bill No. 2272 and Committee Substitute for Senate Bill No. CHAPTER 2010-211 Committee Substitute for Committee Substitute for Senate Bill No. 2272 and Committee Substitute for Senate Bill No. 2722 An act relating to controlled substances; amending s. 456.037,

More information

PARTICIPANT CONTRACT

PARTICIPANT CONTRACT PARTICIPANT CONTRACT, DEKALB COUNTY DRUG/DUI COURT: C.L.E.A.N. PROGRAM (CHOOSING LIFE AND ENDING ABUSE NOW) IN THE CIRCUIT COURT FOR THE SIXTEENTH JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS PARTICIPANT CONTRACT

More information

SAMPLE DRUG AND ALCOHOL POLICY

SAMPLE DRUG AND ALCOHOL POLICY SAMPLE DRUG AND ALCOHOL POLICY (MISSISSIPPI) DRUG AND ALCOHOL POLICY DISCLAIMER WARNING!!! The attached Drug and Alcohol Policy is being furnished to you as a courtesy. Stonetrust Management Services highly

More information

Eligibility Requirements for RN Licensure in the State of Texas

Eligibility Requirements for RN Licensure in the State of Texas February 2015 1 Eligibility Requirements for RN Licensure in the State of Texas These requirements listed here are not exclusive. It is the student s responsibility to update themselves with all requirements

More information

MAT Disclosures & Consents 1 of 6. Authorization & Disclosure

MAT Disclosures & Consents 1 of 6. Authorization & Disclosure MAT Disclosures & Consents 1 of 6 Authorization & Disclosure ***YOUR INSURANCE MAY NOT PAY FOR ROUTINE SCREENING*** *** APPROPRIATE SCREENING DIAGNOSES MUST BE PROVIDED WHEN INDICATED*** Urine Drug Test

More information

THE PROGRAM FOR RECOVERING NURSES (PRN)

THE PROGRAM FOR RECOVERING NURSES (PRN) THE PROGRAM FOR RECOVERING NURSES (PRN) A Program Administered by the Idaho Board of Nursing Important Information for Participants 2012 PRN Mission: To protect the public safety, health and welfare while

More information

This is a Legal Document. By completing and signing this, you certify under penalty of perjury

This is a Legal Document. By completing and signing this, you certify under penalty of perjury APPLICATION FOR WYOMING REGISTERED NURSE (RN) or LICENSED PRACTICAL NURSE (LPN) By EXAMINATION *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this,

More information

PARTICIPANT CONTRACT

PARTICIPANT CONTRACT PARTICIPANT CONTRACT, DEKALB COUNTY DRUG/DUI COURT: C.L.E.A.N. PROGRAM (CHOOSING LIFE AND ENDING ABUSE NOW) IN THE CIRCUIT COURT FOR TWENTY-THIRD JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS PARTICIPANT CONTRACT

More information

Procedure 5202P Personnel

Procedure 5202P Personnel FEDERAL HIGHWAY ADMINISTRATION MANDATED DRUG AND ALOCHOL TESTING PROGRAM Definitions: Accident, for purposes of this policy, is as an incident involving an employee whose job responsibilities require a

More information

Pierce County. Drug Court. Established September 2004

Pierce County. Drug Court. Established September 2004 Pierce County Drug Court Established September 2004 Policies and Procedures Updated September 2013 TABLE OF CONTENTS I. Drug Court Team II. Mission Statement III. The Drug Court Model IV. Target Population

More information

Drug and Alcohol Testing

Drug and Alcohol Testing Drug and Alcohol Testing Original Implementation: July 14, 1998 Last Revision: April 15, 2014 It is the policy of Stephen F. Austin State University to promote a safe, healthy and productive learning and

More information

1 March 2013. HUMAN RESOURCES Employee Drug Testing, Substance Abuse and Drug Free Workplace Policy POLICY Number: B-002

1 March 2013. HUMAN RESOURCES Employee Drug Testing, Substance Abuse and Drug Free Workplace Policy POLICY Number: B-002 HUMAN RESOURCES Employee Drug Testing, Substance Abuse and Drug Free Workplace Policy POLICY Number: B-002 1. AUTHORITY: Director of State Civil Service as contained La. R.S. 36:54 2. REFERENCES: La. R.S.

More information

Ch. 97 DRUG OFFENDER TREATMENT PROGRAM 37 CHAPTER 97. STATE INTERMEDIATE PUNISHMENT DRUG OFFENDER TREATMENT PROGRAM

Ch. 97 DRUG OFFENDER TREATMENT PROGRAM 37 CHAPTER 97. STATE INTERMEDIATE PUNISHMENT DRUG OFFENDER TREATMENT PROGRAM Ch. 97 DRUG OFFENDER TREATMENT PROGRAM 37 CHAPTER 97. STATE INTERMEDIATE PUNISHMENT DRUG OFFENDER TREATMENT PROGRAM Sec. 97.1 97.17. [Reserved]. 97.101. Authority and purpose. 97.102. Definitions. 97.103.

More information

CONNECTICUT GENERAL STATUTES CHAPTER 383c PROFESSIONAL COUNSELORS

CONNECTICUT GENERAL STATUTES CHAPTER 383c PROFESSIONAL COUNSELORS CONNECTICUT GENERAL STATUTES CHAPTER 383c PROFESSIONAL COUNSELORS Sec. 20-195aa. Definitions: As used in sections 20-195aa to 20-195ee, inclusive: "Professional counseling" means the application, by persons

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,

More information

SENATE BILL 1099 AN ACT

SENATE BILL 1099 AN ACT Senate Engrossed State of Arizona Senate Forty-third Legislature First Regular Session SENATE BILL AN ACT amending sections -, -.0, -, -, -, -, -, -, -, - and -, Arizona revised statutes; repealing section

More information

Luna County Position Description

Luna County Position Description Luna County Position Description Position Title: Detention Health Services Administrator POSTED: Thursday, 10/8/15 @ 8:00 a.m. CLOSES: Thursday, 10/15/15 @ 5:00 p.m. Salaried(Y/N) : N Department: Detention

More information

Chapter 388-877B WAC CHEMICAL DEPENDENCY SERVICES. Section One--Chemical Dependency--Detoxification Services

Chapter 388-877B WAC CHEMICAL DEPENDENCY SERVICES. Section One--Chemical Dependency--Detoxification Services Chapter 388-877B WAC CHEMICAL DEPENDENCY SERVICES Section One--Chemical Dependency--Detoxification Services WAC 388-877B-0100 Chemical dependency detoxification services--general. The rules in WAC 388-877B-0100

More information

CHAPTER 3 STANDARDS OF NURSING PRACTICE. The purpose of the board in adopting rules and regulations in this chapter is to:

CHAPTER 3 STANDARDS OF NURSING PRACTICE. The purpose of the board in adopting rules and regulations in this chapter is to: Section 1. Statement of Purpose. CHAPTER 3 STANDARDS OF NURSING PRACTICE (a) The purpose of the board in adopting rules and regulations in this chapter is to: (i) Communicate board expectations and provide

More information

Downloadable Forms: Otsego County Chemical Dependencies Clinic. Client Handbook. Revised 04/10

Downloadable Forms: Otsego County Chemical Dependencies Clinic. Client Handbook. Revised 04/10 Downloadable Forms: Otsego County Chemical Dependencies Clinic Client Handbook Revised 04/10 OTSEGO CHEMICAL DEPENDENCIES CLINIC 242 Main St, 2 nd Floor Oneonta, New York 13820 Tel. (607) 431-1030 Fax.

More information

North Carolina Board of Nursing One Year Sobriety Notebook

North Carolina Board of Nursing One Year Sobriety Notebook North Carolina Board of Nursing One Year Sobriety Notebook TABLE OF CONTENTS Pg. 2-4 Item 1: Information About You Pg. 5 Item 2: Resume Pg. 6-7 Item 3: Employment Since Surrender/Suspension of the License

More information

POLICY TITLE: Employee Drug and Alcohol Testing POLICY NO: 403.50 PAGE 1 of 7

POLICY TITLE: Employee Drug and Alcohol Testing POLICY NO: 403.50 PAGE 1 of 7 POLICY TITLE: Employee Drug and Alcohol Testing POLICY NO: 403.50 PAGE 1 of 7 It is the intent of the board of trustees of this district to promote an alcohol and drug-free workplace, thereby enhancing

More information

Vermont Board of Nursing INSTRUCTION TO APPLICANTS

Vermont Board of Nursing INSTRUCTION TO APPLICANTS Vermont Secretary of State 89 Main St., 3 rd Floor Montpelier VT 05620-3402 Nursing Foreign_nurse@sec.state.vt.us www.vtprofessionals.org INSTRUCTION TO APPLICANTS The following applies to applications

More information

WYOMING LICENSED PRACTICAL NURSE LICENSURE BY ENDORSEMENT, RELICENSURE

WYOMING LICENSED PRACTICAL NURSE LICENSURE BY ENDORSEMENT, RELICENSURE APPLICATION FOR WYOMING LICENSED PRACTICAL NURSE LICENSURE BY ENDORSEMENT, RELICENSURE or REACTIVATION All licenses expire December 31 of every EVEN year INSTRUCTIONS AND GENERAL INFORMATION: Thank you

More information

12 LC 33 4750S A BILL TO BE ENTITLED AN ACT BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

12 LC 33 4750S A BILL TO BE ENTITLED AN ACT BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: The House Committee on Health and Human Services offers the following substitute to SB 368: A BILL TO BE ENTITLED AN ACT 1 2 3 4 5 To amend Chapter 26 of Title 43 of the Official Code of Georgia Annotated,

More information

Both Outpatient Counseling and Residential Substance Abuse Treatment programs shall comply with the following requirements:

Both Outpatient Counseling and Residential Substance Abuse Treatment programs shall comply with the following requirements: SUBSTANCE ABUSE COUNSELING - OUTPATIENT COUNSELING AND RESIDENTIAL TREATMENT (General HIV/AIDS Population & MAI for Residential Treatment) (YEAR 25 Service Priorities #8 for outpatient; and #10 for Part

More information

SCOPE OF PRACTICE FOR ARNPS

SCOPE OF PRACTICE FOR ARNPS FLORIDA'S PROHIBITION ON ADVANCED REGISTERED NURSE PRACTITIONERS (ARNPs) PRESCRIBING CONTROLLED SUBSTANCES AND THE REQUIREMENTS TO REPORT SUCH ACTIVITY Florida is one of the two states that does not allow

More information

CHAPTER 2 Board of Trustees Approval: 06/14/89 POLICY 2.08 Revised: 03/12/97

CHAPTER 2 Board of Trustees Approval: 06/14/89 POLICY 2.08 Revised: 03/12/97 2.08 DRUG FREE WORKPLACE Cabinet Approval: CHAPTER 2 Board of Trustees Approval: 06/14/89 POLICY 2.08 Revised: 03/12/97 I. PURPOSE To provide: (1) an alcohol / drug free workplace for all employees, (2)

More information

LAKE TRAVIS ISD POLICY FOR RANDOM STUDENT DRUG TESTING

LAKE TRAVIS ISD POLICY FOR RANDOM STUDENT DRUG TESTING LAKE TRAVIS ISD POLICY FOR RANDOM STUDENT DRUG TESTING STATEMENT OF NEED AND PURPOSE Lake Travis ISD has a vital interest in maintaining a positive learning environment that is safe and healthy for all

More information

Drugs - shall be defined as those outlined in the Controlled Substance, Drug, Devise and Cosmetic Act.

Drugs - shall be defined as those outlined in the Controlled Substance, Drug, Devise and Cosmetic Act. 4104(a) Personnel Employee Alcohol and Illegal Drug Use Purpose The Boyertown Area Board of School Directors recognizes that the misuse of drugs and alcohol is a serious problem with legal, physical and

More information

The Drug Court program is for addicted offenders. The program treats a drug as a drug and an addict as an addict, regardless of the drug of choice.

The Drug Court program is for addicted offenders. The program treats a drug as a drug and an addict as an addict, regardless of the drug of choice. Drug Court Handbook Mission Statement Drug Courts in the 7th Judicial District will strive to reduce recidivism of alcohol & drug offenders in the criminal justice system and provide community protection

More information

APPLICATION FOR WYOMING REGISTERED NURSE LICENSURE by ENDORSEMENT, RELICENSURE or REACTIVATION All licenses expire December 31 of every EVEN year

APPLICATION FOR WYOMING REGISTERED NURSE LICENSURE by ENDORSEMENT, RELICENSURE or REACTIVATION All licenses expire December 31 of every EVEN year INSTRUCTIONS AND GENERAL INFORMATION: APPLICATION FOR WYOMING REGISTERED NURSE LICENSURE by ENDORSEMENT, RELICENSURE or REACTIVATION All licenses expire December 31 of every EVEN year Thank you for applying

More information

Clay/Becker Veterans Treatment Court. Participant Handbook

Clay/Becker Veterans Treatment Court. Participant Handbook Clay/Becker Veterans Treatment Court Participant Handbook March 2014 THIS BOOK BELONGS TO: NAME: CD TX PROGRAM: COUNSELOR NAME: PHONE NUMBER: AFTERCARE: COUNSELOR NAME: PHONE NUMBER: MENTOR NAME: PHONE

More information

DRUGS AND ALCOHOL. Substance screening may be required of any employee if there exists reasonable suspicion to support such request.

DRUGS AND ALCOHOL. Substance screening may be required of any employee if there exists reasonable suspicion to support such request. DRUGS AND ALCOHOL A. APPLICANTS Substance screening is required for all final applicants applying for a position for which drug testing is required by the provisions of the Omnibus Transportation Employee

More information

The following procedures are established in implementation of Policy No. 5530, Substance Abuse.

The following procedures are established in implementation of Policy No. 5530, Substance Abuse. R5530.DR Page 1 of 11 The following procedures are established in implementation of Policy No. 5530,. A. Definitions 1. Evaluation means those procedures used by a certified or licensed professional to

More information

CHAPTER 19 THE INTERVENTION PROJECT FOR NURSES (IPN) SUBSTANCE ABUSE, REHABILITATION AND DISCIPLINE

CHAPTER 19 THE INTERVENTION PROJECT FOR NURSES (IPN) SUBSTANCE ABUSE, REHABILITATION AND DISCIPLINE CHAPTER 19 THE INTERVENTION PROJECT FOR NURSES (IPN) SUBSTANCE ABUSE, REHABILITATION AND DISCIPLINE I. INTRODUCTION Nurses and other medical professionals are constantly faced with high-stress situations.

More information

HILLSDALE BOARD OF EDUCATION FILE CODE: 5131.6* SUBSTANCE ABUSE

HILLSDALE BOARD OF EDUCATION FILE CODE: 5131.6* SUBSTANCE ABUSE HILLSDALE BOARD OF EDUCATION Hillsdale, NJ 07642 SUBSTANCE ABUSE Possible Drug and Alcohol Related Situations Whenever it shall appear to any teaching staff member, school nurse or other education personnel

More information

Drug and Alcohol Testing for Safety- and Security-sensitive Positions

Drug and Alcohol Testing for Safety- and Security-sensitive Positions [Minor revision posted 3/7/14 (replaces 1/27/12 edition)] Operating Policy and Procedure : Drug and Alcohol Testing for Safety- and Security-sensitive Positions DATE: March 7, 2014 PURPOSE: The purpose

More information

ORDER OF EMERGENCY SUSPENSION OF LICENSE

ORDER OF EMERGENCY SUSPENSION OF LICENSE Final Order No. DOH-I -2295- QA FILED DATE -R AA Department of Health STATE OF FLORIDA DEPARTMENT OF HEALTH In Re: Emergency Suspension of the License of By Deputy Agency Clerk ORDER OF EMERGENCY SUSPENSION

More information

Substance Abuse Treatment Services Policy

Substance Abuse Treatment Services Policy Substance Abuse Treatment Services Policy Rhode Island Department of Children, Youth and Families Policy: 700.0195 Effective Date: June 1, 2000 Version: 1 The Department frequently works with families

More information

ASSERTIVE COMMUNITY TREATMENT TEAMS CERTIFICATION

ASSERTIVE COMMUNITY TREATMENT TEAMS CERTIFICATION ARTICLE 5.2. ASSERTIVE COMMUNITY TREATMENT TEAMS CERTIFICATION Rule 1. Definitions 440 IAC 5.2-1-1 Applicability Sec. 1. The definitions in this rule apply throughout this article. (Division of Mental

More information

ADMINISTRATION OF MEDICATION

ADMINISTRATION OF MEDICATION ADMINISTRATION OF MEDICATION IN SCHOOLS MARYLAND STATE SCHOOL HEALTH SERVICES GUIDELINE JANUARY 2006 (Reference Updated March 2015) Maryland State Department of Education Maryland Department of Health

More information

A $100.00 application fee in the form of a money order made payable to LSBN must accompany this form

A $100.00 application fee in the form of a money order made payable to LSBN must accompany this form OFFICE USE ONLY: APPROVED BY (initial) DATE PERMIT ISSUED RN LICENSE NUMBER DATE RN LICENSE ISSUED ATTACH PHOTO With tape only - Attach a 2 x 2 inch passport type, fade-proof photo taken in the last six

More information

FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY

FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY DENTAL RADIOGRAPHY CERTIFICATION APPLICATION Chapter 466.004 and 466.017(5), Florida Statutes Rule 64B5-9.011, Florida Administrative Code SPECIAL TES AND INSTRUCTIONS: 1. A N-REFUNDABLE fee of $35.00

More information

BACHELOR OF SCIENCE IN NURSING STUDENT HANDBOOK 45

BACHELOR OF SCIENCE IN NURSING STUDENT HANDBOOK 45 BACHELOR OF SCIENCE IN NURSING STUDENT HANDBOOK 45 Drug Testing Policy Background: The Muskingum University Department of Nursing (DON) drug testing policy was established to meet contractual requirements

More information

APPLICATION FOR WYOMING REGISTERED NURSE LICENSURE with APRN RECOGNITION All licenses expire December 31 of every EVEN year

APPLICATION FOR WYOMING REGISTERED NURSE LICENSURE with APRN RECOGNITION All licenses expire December 31 of every EVEN year APPLICATION FOR WYOMING REGISTERED NURSE LICENSURE with APRN RECOGNITION All licenses expire December 31 of every EVEN year INSTRUCTIONS AND GENERAL INFORMATION: Thank you for applying to the Wyoming State

More information

MEMORANDUM. Employees. Human Resources AGENCY DRUG-FREE WORKPLACE POLICY

MEMORANDUM. Employees. Human Resources AGENCY DRUG-FREE WORKPLACE POLICY MEMORANDUM TO: FROM: RE: Employees Human Resources AGENCY DRUG-FREE WORKPLACE POLICY Attached is a copy of the Mississippi Department of Health s established Drug-Free Workplace Policy. This policy reflects

More information

EFFECTIVE DATE: 10/04. SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31

EFFECTIVE DATE: 10/04. SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31 SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31 EFFECTIVE DATE: 10/04 Applies to all products administered by the plan except when changed by contract Policy Statement:

More information

SUBSTANCE ABUSE OUTPATIENT

SUBSTANCE ABUSE OUTPATIENT SUBSTANCE ABUSE OUTPATIENT Service Category Description Substance abuse services - outpatient is the provision of medical or other treatment and/or counseling to address substance abuse problems (i.e.,

More information