New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-A - Former Office of Alcohol and Drug Abuse Prevention
Chapter He-A 900 - PHASE II PROGRAMS
Part He-A 907 - MINIMUM PROGRAM REQUIREMENTS
Section He-A 907.09 - Phase II Intake Interview
Universal Citation: NH Admin Rules He-A 907.09
Current through Register No. 52, December 26, 2024
(a) There shall be an initial one-on-one intake interview between the client and a LADC, or a phase II program staff member under LADC supervision.
(b) The intake interview shall take place prior to, and separate from, course sessions.
(c) The intake interview shall include the following steps:
(1) The client shall provide
the phase II program with the documents required pursuant to
He-A
904.04;
(2) The client shall complete the diagnostic
instruments;
(3) The LADC shall
complete Form IDIP-011, client profile, by including the following printed or
typewritten information:
a. The facility
code;
b. The section where the
client is assigned;
c. The last
four digits of the client's Social Security number;
d. The client's name;
e. The client's initials;
f. The program type;
g. The client's address;
h. The client's date of birth;
i. The date of the client's intake
interview;
j. The client's
gender;
k. Whether the client is
restarting a program;
l. The court
of the client's conviction;
m. The
date of the client's arrest;
n. The
client's blood alcohol test results, or an indication of the client's refusal
of consent;
o. All of the client's
DWI convictions, including the current one, and drug impaired driving
convictions, unless otherwise protected by law;
p. All DWI courses previously attended by the
client;
q. The client's marital
status;
r. The client's education
level;
s. The client's
occupation;
t. The client's current
income;
u. Whether the program fee
was reduced due to financial hardship;
v. The client's history of treatment for any
other alcohol or other substance abuse problem;
w. The frequency of alcohol consumption in
the past;
x. The signature of the
LADC completing the top of the form, which shall not be printed or
typewritten;
(4) The
client shall provide to the LADC completing Form IDIP-011, client profile, the
information required in (3) c., o. through t., v., and w.;
(5) The client shall complete Form IDIP-019,
consent for the release of confidential information, specifically for the
department, the convicting court, and the department of safety, by including:
a. The client's name;
b. The name and address of the convicting
court; and
c. The client's dated
signature;
(6) The
provider staff member shall sign and date Form IDIP-019, consent for the
release of confidential information;
(7) The client shall read and complete Form
IDIP-016, phase II client agreement, by including:
a. The client's name; and
b. The client's dated signature, indicating
that he or she has read the form and agrees to attend the identified sessions;
and
(8) The provider
staff member shall complete Form IDIP-016, phase II client agreement, by
including:
a. The class location of the phase
II program, including the street address, city or town, and telephone
number;
b. All scheduled session
days, dates, times, and instructors; and
c. The dated signature of the phase II staff
member.
(d) The client shall complete, read and sign any other department-approved forms and materials which are provided by each agency to cover the agency's individual program policies, procedures, or other information.
#7058, eff 7-21-99; ss by #8902, INTERIM, eff 7-13-07, EXPIRED: 1-9-08
New. #9082, eff 1-30-08 (from He-A 907.10)
Disclaimer: These regulations may not be the most recent version. New Hampshire may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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