Get Out Of State Dwi - Life Changes Eap

Filling out the Out Of State DWI - Life Changes EAP form can seem challenging, but with the right guidance, it becomes manageable. This guide offers a clear and supportive pathway through each section of the form to help you fulfill your requirements effectively.

Follow the steps to fill out the form online

1. Press the ‘Get Form’ button to obtain the Out Of State DWI - Life Changes EAP form and open it in your chosen editor.
2. Begin by entering the date at the top of the form. This ensures that your submission is accurate and timely.
3. Complete the section for NC DWI Agency by entering 'Life Changes Counseling' along with the provided address and fax number.
4. Fill in the referral's name: Start with the last name, followed by the first and middle names. Make sure to double-check the spelling.
5. Enter the social security number. This is crucial for identification and processing.
6. Input the date of birth in the specified format, ensuring the month, day, and year are separated correctly.
7. Provide the complete address, including street, city, state, and zip code.
8. List the telephone numbers. Include both home and cell or work numbers to ensure you can be contacted easily.
9. Record the driver's license number along with the state that issued it. This is important for verifying identity.
10. Document the date of conviction and the blood alcohol content (BAC) at the time of the offense.
11. Indicate any prior DUI/DWI convictions or relevant driving record information.
12. Enter the testing instrument used in the assessment, ensuring that it is appropriate and acknowledged.
13. In the recommendation section, evaluate the assessment diagnosis using the provided options. Mark the relevant box.
14. Complete the completion status section, providing necessary details for alcohol/drug education and treatment, including intake and completion dates.
15. Ensure that you attach any appropriate documentation and discharge summary after filling in the treatment details.
16. Complete the section for additional information, including agency name and counselor credentials.
17. Remember to sign the document, as this confirms the accuracy of the information provided.
18. Once finished, review the entire form for accuracy, then save your changes, download, print, or share the completed form as necessary.

Complete your Out Of State DWI - Life Changes EAP form online now to ensure compliance with your requirements.