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  • Wellness Exceptiondisease Management Form

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DriveTime Benefits fx: 8885057130 www.drivetimebenefits.com benefits drivetime.com Wellness Exception/Disease Management Form Dear Employee, Please complete the line below and take this form to your.

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Requirements include: OTPs must be both certified and accredited; Licensed by the state in which they operate; and. Registered with the Drug Enforcement Administration (DEA), through their local DEA office.

How to Submit an Exception Request. Exception requests must be made using Form SMA-168: Exception Request and Record of Justification. Login to the Extranet website to access Form SMA-168. This form must be submitted via the SAMHSA OTP Extranet website for review by both the state opioid treatment authority and SAMHSA.

A limitation of this regulation includes that “not more than one day's medication may be administered to the person or for the person's use at one time. Such emergency treatment may be carried out for not more than three days and may not be renewed or extended.”

eCFR :: 42 CFR Part 8 -- Medication Assisted Treatment for Opioid Use Disorders.

OTPs provide medication-assisted treatment (MAT) for people diagnosed with an opioid-use disorder. MAT patients also must receive counseling, which can include different forms of behavioral therapy. Learn more about medication and counseling treatment for substance use disorders.

The Code of Federal Regulations Title 42 contains the codified U.S. Federal laws and regulations that are in effect as of the date of the publication pertaining to public health in the United States and its territories, including Medicare and Medicaid.

An opioid treatment program (OTP) is defined as "a program or practitioner engaged in opioid treatment of individuals with an opioid agonist medication."

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232