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The forms below are required for ADTP contractors and are available for downloading. These forms are due as indicated in the Provider Reporting Requirements Timeline FY 2010-2011.
Original forms must be submitted via standard mail to: ADTP 10 North San Pedro Road, Suite 1013 San Rafael, CA 94903. Completed forms MUST be received on or before the dates indicated in the Provider Reporting Requirements Timeline FY 2010-2011 or payment for services may be delayed or denied.
All forms are available as Microsoft Word or Microsoft Excel documents. If you are unable to use these formats, please contact our office and we will send you a copy of the appropriate form(s).
Primary Prevention Providers
Primary Prevention providers should be reporting all activity in the on-line CalOMS Prevention system. The on-line reporting system is located at CalOMS Prevention
Secondary Prevention Providers
 Client and Service Activity List for Secondary Prevention
Sample Outreach Log for Code 19
Client Activity List - Monthly Billing
Treatment providers that are utilizing the Drug and Alcohol Treatment Access Report (DATAR) should enter that information on-line at the California Department of Alcohol and Drug Programs DATAR website
Reporting Forms: Substance Abuse and Crime Prevention Act Providers PC1210 Client Tracking Form
PC1210 Monthly Progress Report
PC1210 Discharge Template
PC1210 Provider Activity List - Monthly Billing
Reporting Forms: Bay Area Service Network (BASN) Monthly Activity Report - Parolee Services Network
Monthly Tracking Form - Parolee Services Network
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