Program information and forms are available below. Participant information is available on the Client Site.
Release of Information Forms
A signed Release of Information (ROI) Consent Form for all of your providers must be on file with PAS. Completed consent forms may be faxed to (720)213-1007.
Program Participant Forms
Contact Change Form – 1/14
Provider Verification Form – 2/13
Relapse Prevention Plan Form – 8/12
Travel Request Form – 1/14
Pre-Employment Checklist – 10/11
Rehabilitation Contract Reports
Rehabilitation Contract reports are due on the 4th of the month. (Reports for the January reporting period are due February 4th.)
Email reports to: firstname.lastname@example.org
Notice to clients: Standard email is an unsecured method of correspondence; therefore reports submitted via this method may be at risk for interception. PAS uses ZixCorp encryption for all email communication with clients.
Participants may choose one of the four Self-Status Reports to submit each reporting period, it is not necessary to submit all four versions.Addictionologist Report – 9/13 Annual History & Physical – 4/17 Meeting Verification– 8/13
Group Meeting Verification – 8/13
Psychiatrist Report –4/13
Self Status –4/13
Self Status Wellness Plan – 4/13
Sponsor Report –4/13
LPN Supervisor Report – 4/13
RN Supervisor Report –8/15
Pharmacist Supervisor Report – 4/13
Therapist Report– 4/13