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DEA Employee Assistance Program Forms

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.)

View flyer

Register for the training on Friday, April 3 (4-7 pm CST), or Saturday, April 4 (11am – 2pm CST).


#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

#11 Authorization to Extend Sessions

#13 Consultation Request Form

#14 Consultation Service Receipt

#15 Request for Training

Consent to use Teletherapy or Telephone Sessions

Confidentiality Guidelines (EAP)

COVID-19 Resources

Public Safety Peer Support/Supervisor Coach App

Links

Articles

Handouts

Surveys/Tests

Recommended Reading

DEA Employee Assistance Program Forms

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