Compliance Forms & Brochures

The forms and brochures utilized by the Compliance Section are provided below.


Forms

Academic Performance Evaluation Form [PDF Format - 48KB]

Academic Verification Form [PDF Format - 32KB]

Components of Mental Health and/or Chemical Dependency Evaluations [PDF Format - 25KB]

Counselor Evaluation Form [PDF Format - 58KB]

Counselor/Therapist Verification Form [PDF Format - 32KB]

Employer Verification Form [PDF Format - 32KB]

List of Evaluators by City [PDF Format - 49KB]

Medication Self Report [PDF Format - 37KB]

Meeting Documentation Form [PDF Format - 22KB]

Monthly Self Report [PDF Format - 30KB]

Prescription Medication Report [PDF Format - 46KB]

Probation/Parole Report [PDF Format - 40KB]

Probation/Parole/Drug Court Verification Form [PDF Format - 32KB]

Relapse Prevention Plan [PDF Format - 48KB]

Treating Practitioner Verification Form [PDF Format - 32KB]

Waiver of Confidentiality [PDF Format - 30KB]

Work Performance Evaluation Form  [PDF Format - 63KB]


Brochures

Criminal Convictions Brochure [PDF Format - 28KB]

KARE Participant Handbook [PDF Format - 99KB]

Kentucky Alternative Recovery Effort (KARE) for Nurses Brochure [PDF Format - 60KB]

Nursing Licensure: Disciplinary Process and Procedures [PDF Format - 139KB]

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