DEA Employee Assistance Program Forms | The Counseling Team International

TCTI is sponsoring this FREE Telemental Health Training which is being offered to all our valued DEA EAP contracted clinicians in response to the COVID-19 crisis. We appreciate the work that each of you do for DEA EAP as well as the unwavering, professional support that you provide for our clients. The COVID-19 crisis has forced each of us to rethink and restructure the way we conduct business for our own safety and that of our clients. As a token of our thanks and appreciation to all our providers, in addition to the free training and follow up Q&A session, we are offering 3 free CEUs. To be eligible to earn the CEU, providers must attend one of the 3-full-hour training sessions being offered, as well as one of the Q&A follow-up sessions, and pass the CE quiz with a minimum score of 80%.

(Please check with your local state licensing board regarding application of CEU to your licensure requirements. Each state governing board has their own requirements, laws and regulations. This CEU may not be applicable in your state.)

Dear DEA EAP Clinicians,

Per our contract with the DEA, all EAP records must be destroyed every 3 years per federal laws and regulations. You can review the Retention & Destruction Policy contained on this form and are welcome to contact us with any questions.

Once you have reviewed the policy, please destroy your DEA EAP records accordingly. Please destroy all DEA EAP records dated on or before September 31, 2018 (Case Number: 1800-XXXX).

Upon completion of records destruction, please print, sign, and submit the Declaration of Records Retention & Disposal Form to our office NO LATER THAN 12/30/21. We will undergo a Performance Evaluation audit in early 2022 and it is crucial that we are in compliance with the policies set forth in our contract with the DEA EAP.

Forms can be faxed to 760-636-0437, or emailed to: deaeapbilling@thecounselingteam.com

If you have any questions or need additional information, please call us at 800-651-1021.

#1 Admission

#2 Statement of Understanding Blank

#3 Service Receipt

#3b Area Clinician Multi-Use Service Receipt (3-28)

#4 Client Satisfaction Survey

#5 Consent for Release of Confidential Information

#7 Threat of Violence Action Form

#8 Clinician Self Referral Disclosure Form

#9 Traumatic Incident Report Form

#10 Formal Supervisory Referral Authorization to Release Confidential Information