EAP Forms
- EAP Case Activity and Billing Form (PDF)
- Instructions. (PDF)
- Authorization to Disclose Health Information (Word)
- Authorized Representative Form (Word)
- Revocation of Authorization to Disclose Health Information (Word)
- Revocation of Authorization (Español) (PDF)
- Personal Representative Revocation of Authorization (PDF)
- Authorization for Use or Disclosure of Information for Formal or Mandatory Referrals to the EAP (PDF)
- Authorization for Use or Disclosure of Medical Information - DOT Referrals (PDF)
- EAP Participant Statement of Understanding (PDF)
- EAP Participant Statement of Understanding (Español) (PDF)
- EAP Participant Statement of Understanding - Formal or Mandatory Referrals (PDF)
- EAP Participant Statement of Understanding - Formal or Mandatory Referrals (Español) (PDF)