These instruments are used by OASAS Staff during Regulatory Compliance Site Reviews.
Image of a report. Certification (PPD) Changes to existing Part 820 Residential Services Application Image of a report. Reporting (PAS) Capital Project Funding Request Form Image of the outline of New York State. Consent and Authorization (TRS)TRS-1 A prohibition of re-disclosure of information accompanies all disclosure consent forms concerning substance use disorder patients. Multiple languages available.
Image of the outline of New York State. Consent and Authorization (TRS)TRS-2 Generic Part 2 Consent Form concerning substance use disorder patients. Multiple languages available.
Image of the outline of New York State. Consent and Authorization (TRS)TRS-2.2 Used to withdraw consent previously granted. Multiple languages available.
Image of the outline of New York State. Consent and Authorization (TRS)TRS-3 Consent to disclose information concerning substance use disorder, patient's presence in facility, and general medical condition to friends or relatives. Multiple languages available.
Image of the outline of New York State. Consent and Authorization (TRS)TRS-4 Irrevocable consent to communicate with criminal justice agencies/persons. Multiple languages available.
Image of the outline of New York State. Consent and Authorization (TRS)TRS-5 Consent to Disclose confidential HIV/AIDS Information. Multiple languages available.