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Fill Out a Valid 508 From Nc Dwi Services Form

The 508 From NC DWI Services form is a critical document used for assessing individuals involved in Driving While Impaired (DWI) cases in North Carolina. This form captures essential information regarding the assessment process, compliance with state regulations, and the necessary documentation for treatment referrals. To ensure accurate processing, it is vital to fill out the form correctly; click the button below to get started.

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Fill Out a Valid 508 From Nc Dwi Services Form

Structure

The 508 Form from North Carolina's DWI Services is a critical document used in the assessment and monitoring of individuals who have been charged with Driving While Impaired (DWI) or related offenses. This form encompasses various sections that ensure compliance with state policies and guidelines. It begins with the collection of essential information, including the provider's name, client details, and assessment date. The form evaluates staff credentials, confirming that assessment providers are qualified according to state regulations. Additionally, it requires clinical assessments to determine the presence of any substance use disorders, including specific DSM-IV diagnoses. The documentation section mandates that a Certificate of Completion be submitted within two weeks of the assessment date, ensuring timely processing of client records. Furthermore, it addresses the Driving While License Revoked (DWLR) assessments, detailing necessary diagnoses and treatment referrals. Areas of non-compliance are documented, and corrective action plans are required when findings do not meet established standards. This comprehensive approach is designed to promote accountability and ensure that clients receive appropriate care and support throughout their recovery process.

Common mistakes

Inaccurate Client Information: Failing to provide the correct client name, record number, or assessment date can lead to confusion and delays.
Missing Signatures: Not obtaining the client’s signature on the consent form for the release of information can invalidate the assessment process.
Incorrect DSM-IV Codes: Entering wrong or incomplete DSM-IV codes for diagnosis can result in non-compliance with assessment requirements.
Failure to Document Submissions: Not recording the date the Certificate of Completion was sent to the State Office can cause issues with tracking compliance.
Neglecting to Address Holds/Rejections: Ignoring holds or rejects in the e508 system related to the client’s record can lead to further complications.
Incomplete Assessment Ratings: Failing to check all necessary boxes for compliance ratings can result in an incomplete assessment.
Omitting Comments: Not providing necessary comments or explanations for areas of non-compliance can hinder the corrective action process.
Incorrectly Marking DWLR Assessments: Mislabeling a Driving While License Revoked (DWLR) assessment can lead to incorrect processing of the assessment.
Not Following Up on Corrections: Failing to implement or document a Plan of Correction when required can result in ongoing compliance issues.

Preview - 508 From Nc Dwi Services Form

NC DIVISION OF MH/DD/SAS

2010-2011 DWI MONITORING TOOL 2 – ASSESSMENT/E508 SYSTEM

Areas deemed not met are documented on the Review Findings and Exit Form. Forms are signed by the Provider indicating acknowledge of findings that result in Plan(s) of Correction as required by Division Policy ACC002 and the Office of DWI Services.

PROVIDER/FACILITY NAME:	PROVIDER CODE:

CLIENT NAME:	RECORD #:

ASSESSMENT DATE:	CONTROL #:

SYSTEM COMPLIANCE FOR ASSESSMENT/CERTIFICATE OF COMPLETION

0 = NOT MET; 1 = MET; 9 = NOT APPLICABLE

RATING

Check √ if this is a Driving While License Revoked (DWLR) Assessment □

SECTION I: STAFF CREDENTIALS/APPROVALS – ASSESEMENT PROVIDERS

In accordance with 10A NCAC 27G.0104

1. Staff is qualified to complete assessments as verified by NCSAPPB.

SECTION II: CLINICAL ASSESSMENT

2. Evidence of DSM-IV diagnosis is present as determined by clinical assessment.

DSM IV Codes: Alcohol Dependence 303.90:	_____
Alcohol Abuse 305.00:	_____
Other: Indicate Disorder or Code: _____
ADETs: No Diagnosis	_____

NOTE: FOR DWLR ASSESSEENTS: Enter “9” and complete Section IV.

3.Evidence of ASAM Patient Criteria is present as determined by clinical assessment.

4.Client Signature is present indicating they were given an updated list of all DWI Providers within their service area.

5.The client signature is present on the Consent Form for Release of Information and includes the various agencies for communicating and reporting findings. (10A NCAC 27G .3807 (d).

SECTION III: DOCUMENTATION: CERTIFICATE OF COMPLETION – e508 SYSTEM

In accordance with Division Policy 0108 eff. 2/1/2008 and Division Policy 1207 eff. 12/1/2007

6.There is evidence that Certificate of Completion was submitted within two (2) weeks of the assessment date.

Assessment Date:_____________ Date Sent to State Office: ____________

7.There is evidence that the provider has managed the e508 system to ensure every step of the process has been completed for the assessment. (Exceptions Noted).

8.The provider has made efforts to resolve holds/rejects within the e508 system that are associated with this client record. (Exceptions Noted).

2010-2011 DWI Monitoring Tool 2

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NC DIVISION OF MH/DD/SAS

2010-2011 DWI MONITORING TOOL 2 – ASSESSMENT/E508 SYSTEM

9.Certificate of Completion Form which indicates date sent to State Office has been signed by professional staff and placed within client file. (Date Sent to State Office does not indicate <blank>).

SECTION IV: DRIVING WHILE LICENSE REVOKED – DWLR

In accordance with Statutory Reference G.S. 20-28

10.Diagnosis was based on clinical assessment that indicates:

a.Early Full Remission _____

b.Sustained Remission _____

c. Partial Remission	_____
d. Other:	_____

11.Client was referred to treatment based on diagnosis of partial remission.

OVERALL

10.

11.

COMMENTS: (Use Additional Comments Sheet as needed)

Findings require corrective actions: (Circle) YES

Auditor Instructions

Use Comments section to indicate areas of noncompliance that result in a Plan of

Correction (POC) and provide details to support findings

Reviewer Signature:

Date:

2010-2011 DWI Monitoring Tool 2

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NC DIVISION OF MH/DD/SAS

2010-2011 DWI MONITORING TOOL 2 – ASSESSMENT/E508 SYSTEM

ADDITIONAL COMMENTS

_________________________________________________________________________________________________________

2010-2011 DWI Monitoring Tool 2

Page 3

NC DIVISION OF MH/DD/SAS

2010-2011 DWI MONITORING TOOL 2 – ASSESSMENT/E508 SYSTEM

ADDITIONAL COMMENTS

_________________________________________________________________________________________________________

2010-2011 DWI Monitoring Tool 2

Page 4

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Documents used along the form

The 508 Form from NC DWI Services is an important document in the assessment process for individuals with DWI charges. However, it is often accompanied by several other forms and documents that help provide a comprehensive overview of the assessment and treatment process. Below is a list of related documents that are commonly used alongside the 508 Form.

Review Findings and Exit Form: This form documents areas that were not met during the assessment. It is signed by the provider, indicating acknowledgment of the findings and any necessary corrective actions.
Plan of Correction (POC): When noncompliance is identified, a POC outlines the steps that will be taken to address the issues. This plan is essential for ensuring that the provider meets the required standards set by the Division.
Certificate of Completion: This document confirms that the assessment process has been completed and submitted to the State Office within the required timeframe. It is crucial for tracking the progress of the client.
Consent Form for Release of Information: This form allows the sharing of the client’s information with various agencies involved in their treatment. It is important for maintaining transparency and communication among providers.
Motorcycle Bill of Sale Form: Essential for documenting the sale and purchase of motorcycles in Texas, this form provides proof of transaction and ownership transfer. For further details, you can visit https://autobillofsaleform.com/motorcycle-bill-of-sale-form/texas-motorcycle-bill-of-sale-form/.
DSM-IV Diagnosis Documentation: This document provides evidence of any mental health diagnoses made during the assessment. It is essential for determining the appropriate treatment plan for the client.
ASAM Patient Criteria Documentation: This form outlines the criteria used to assess the client’s needs based on the American Society of Addiction Medicine guidelines. It plays a key role in ensuring that the client receives the right level of care.

Understanding these documents and their purposes can help individuals navigate the DWI assessment process more effectively. Each form plays a vital role in ensuring compliance, facilitating treatment, and supporting the client’s journey toward recovery.

Similar forms

The 508 Form from NC DWI Services shares similarities with the Substance Abuse Assessment form. Both documents are used to evaluate an individual's substance use and its impact on their behavior, particularly in relation to driving offenses. They require clinical assessments that may include the DSM-IV diagnosis, ensuring that the evaluation is thorough and based on established criteria. Additionally, both forms necessitate client signatures, indicating that clients have been informed about their treatment options and the services available to them.

Another document comparable to the 508 Form is the Treatment Plan form. This form outlines the specific interventions and goals established for clients following their assessment. Like the 508 Form, it emphasizes the importance of individualized care and requires documentation of the client’s progress. Both documents also serve as tools for providers to track compliance with state policies and ensure that clients receive the necessary support throughout their recovery journey.

The Exit Form is another document that aligns with the 508 Form. This form records the findings from the assessment and any necessary follow-up actions. It is essential for documenting areas that were not met and for creating a Plan of Correction. Similar to the 508 Form, the Exit Form requires signatures from providers to acknowledge the findings and ensure accountability in the treatment process.

The Certificate of Completion is also akin to the 508 Form, as it serves as proof that a client has completed the required assessment and any subsequent treatment. This document must be submitted within a specific timeframe, reflecting the urgency and importance of timely compliance with state regulations. Both forms emphasize the need for thorough documentation and timely communication with state offices to maintain compliance with DWI services.

In addition to the forms mentioned, it's important for individuals to be aware of the legal and financial documents related to mobile home transactions. For instance, the Mobile Home Bill of Sale is essential for ensuring a legitimate transfer of ownership and protecting the rights of both the buyer and seller. Understanding such documents is crucial in maintaining compliance and clarity throughout the process.

The Client Consent Form is another related document. This form ensures that clients understand and agree to the sharing of their information among relevant agencies. Like the 508 Form, it emphasizes the importance of informed consent and the client's right to privacy. Both documents highlight the need for transparency and communication in the treatment process, ensuring that clients are aware of how their information will be used.

Lastly, the Monitoring Tool is similar to the 508 Form in its purpose of evaluating compliance with state policies regarding DWI assessments and treatments. Both documents provide a framework for assessing the quality of services offered to clients and require detailed documentation of findings. They also share the goal of improving client outcomes by ensuring that providers adhere to established guidelines and best practices in the field.

Dos and Don'ts

When filling out the 508 Form for NC DWI Services, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are six things you should and shouldn't do:

Do: Ensure all required fields are completed accurately.
Do: Verify that staff credentials are up to date and meet the necessary qualifications.
Do: Include the client’s signature on the Consent Form for Release of Information.
Do: Submit the Certificate of Completion within two weeks of the assessment date.
Do: Document any areas of noncompliance clearly in the comments section.
Do: Review all information before submission to avoid errors.

Don't: Leave any sections blank unless they are marked as not applicable.
Don't: Forget to sign the Certificate of Completion Form.
Don't: Ignore any holds or rejects in the e508 system; address them promptly.
Don't: Use outdated or incorrect DSM-IV codes for diagnoses.
Don't: Overlook the importance of accurate documentation for all findings.
Don't: Submit the form without a thorough review of all entries.

Key takeaways

Filling out and utilizing the 508 Form from NC DWI Services is an important process that requires attention to detail. Here are some key takeaways to consider:

Understand the Purpose: The form is used for assessing individuals with DWI (Driving While Intoxicated) offenses, ensuring compliance with state regulations.
Accurate Documentation: It is essential to provide accurate information, including the client’s name, assessment date, and provider details.
Credential Verification: Ensure that the assessment provider's credentials are verified according to the standards set by the NCSAPPB.
Client Involvement: The client must sign the form to confirm they received an updated list of DWI providers in their area and consent to information sharing.
Timely Submission: The Certificate of Completion must be submitted within two weeks of the assessment date to ensure compliance.
Addressing Noncompliance: Any areas not meeting standards must be documented, and a Plan of Correction should be developed as needed.
Follow-Up Actions: Providers should actively manage the e508 system to resolve any holds or rejects associated with the client’s record.

By keeping these takeaways in mind, individuals and providers can navigate the 508 Form process more effectively, ultimately supporting the rehabilitation and compliance of those involved.

How to Use 508 From Nc Dwi Services

Completing the 508 Form for NC DWI Services requires careful attention to detail. This form is crucial for documenting assessments and ensuring compliance with state regulations. After filling out the form, you will need to submit it along with any required documentation to the appropriate office.

Begin by entering the Provider/Facility Name and Provider Code at the top of the form.
Fill in the Client Name and Record # in the designated fields.
Input the Assessment Date and Control # in their respective areas.
If applicable, check the box to indicate if this is a Driving While License Revoked (DWLR) Assessment.
In Section I, confirm that the staff is qualified to complete assessments and provide verification details.
Move to Section II and document evidence of DSM-IV diagnosis, including the relevant codes for Alcohol Dependence and Alcohol Abuse.
Check if evidence of ASAM Patient Criteria is present as determined by clinical assessment.
Ensure the client signature is present, indicating they received an updated list of DWI Providers in their area.
Verify that the client has signed the Consent Form for Release of Information.
In Section III, confirm that the Certificate of Completion was submitted within two weeks of the assessment date.
Document the date sent to the State Office and ensure all steps in the e508 system have been completed.
Check that any holds or rejects associated with the client record have been addressed.
Ensure the Certificate of Completion Form is signed by professional staff and included in the client file.
In Section IV, provide the diagnosis based on the clinical assessment, including remission status.
Complete the comments section, noting any findings that require corrective actions.
Finally, have the reviewer sign and date the form.