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Quarterly Compliance Reports

compliance-tag
Your Monitoring Plan identifies who is to submit quarterly compliance reports about you. At a minimum, we need quarterly reports from you, your treatment provider, and your work site monitor (if you are practicing in your licensed field). Your plan may also require reports from your recovery sponsor and additional treatment providers.

HPSP sends an introductory letter with a sample report form to your work site monitor(s) and your treatment provider(s) informing them of your participation in the program and requesting quarterly reports. However, after this initial letter, you are expected to ensure the reports are submitted on time. We recommend you discuss the importance of your reports being submitted on time with these individuals. Do not assume that they will routinely remember to send reports each quarter. Reminders from you are helpful. Consider providing them with a blank report form, as well as a stamped, addressed envelope the report will be mailed.


Report Forms


Types of Reports Requested


Quarterly Participant Update Reports

You will complete and return Participant Update forms to HPSP on a quarterly basis. Please provide a thoughtful review of symptoms you are experiencing, your recovery or care plan, successes or challenge you are facing, information about your employment status and a summary of your future plans.

Important: Notify HPSP immediately of any changes in your living situation, address, phone number, employment, work site monitor, and treatment providers.

Quarterly Treatment Provider Reports

Throughout monitoring, you will see a treatment provider to monitor your continuing recovery, even after your illness stabilizes. Your Monitoring Plan identifies the provider(s) that will provide  Quarterly Treatment Provider Reports. HPSP may seek reports from other providers as needed.

Important: Both your treatment provider and you should notify us immediately if you experience an exacerbation of symptoms, or if there is concern about your ability to practice safely.

Quarterly Work Site Monitor Reports

Quarterly Work Site Monitor Reports from work site monitors provide us with information about your professional performance. All HPSP participants working in their licensed/regulated fields are required to identify a work site monitor. If you work in more than one setting, you need a work site monitor in each setting. This person is typically your direct supervisor and should never be a peer, unless approved by HPSP. If you do not have a supervisor because you are in private practice or for other reasons, we will work with you to identify someone to serve as a work site monitor.

Important: Your work site monitor and you must agree to notify us immediately if there are any concerns about your practice.

Mutual Support Group Meeting ATTENDANCE FORMS or SPONSOR FORMS*

Participants diagnosed with a substance use disorder are required to obtain a sponsor and attend mutual support group meetings. To verify meeting attendance, ask to have your sponsor send quarterly reports about you using the provided Sponsor Forms, or you can provide us with documentation of your attendance at meetings using the Mutual Support Group Meeting Attendance Forms. We will provide you with report forms to give your sponsor, as HPSP does not request an authorization to communicate with that individual.  You can also download attendance forms or additional sponsor forms by clicking on the above links.

Professionals Support Group Attendance or Facilitator Report*

HPSP requires participants with substance use disorders to attend professional support groups when they are available. Examples include Dentists Concerned for Dentists, Pharmacists Recovery Network, Physicians Serving Physicians or other available groups. Upon receipt of your signed Authorization, we will send the group facilitator Facilitator Report Forms to complete.

Monthly Medication Logs*

Monthly Medication Logs document your use of controlled or other potentially abusable substances. Submit medication logs to HPSP at the end of each month or sooner if you have completed the prescription.

Important: When you are prescribed a controlled or potentially abusable substance, remember to notify your case manager with in 24-hours and provide HPSP with a copy of the prescription within three business days. Track you use of the medication from the first to last dose. Any unused medications should be discarded, and your case manager should be notified as to when it was discarded.

*These reports are generally only required for persons being monitored for substance use disorders.