Quarterly Compliance Reports

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.

Forms should be sent to HPSP via email at hlbhpsp@state.mn.us or fax to 651-797-1380, or mail to HPSP at 1360 Energy Park Drive Suite 220, St. Paul, MN 55108.

Submit Documents Via Email

Quarterly Participant Update Reports

Complete and return a Participant Update (PDF) form to HPSP on a quarterly basis. Please provide a thoughtful review of symptoms you may be experiencing, your recovery or care plan, successes or challenges 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 for continuing recovery, even after your illness stabilizes. Your Monitoring Plan identifies the provider(s) that will provide us with quarterly Treatment Provider TP Report Form (PDF). We 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

If you are working in your licensed/regulated profession, you are required to identify a work site monitor who will provide us quarterly Work Site Monitor Report (PDF) reports, which provide us with information about your professional performance. All HPSP participants working in their licensed/reIf 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, your sponsor may send quarterly Sponsor (PDF) forms about your participation, or you can provide us with documentation of your attendance at meetings using the Mutual Support Group Meeting Attendance (PDF) form. We will provide you with report forms to give your sponsor. 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. Review the Professional Support Meeting List form to identify a meeting near you. Please help us keep this list up to date.

For those attending Pharmacists Recovery Network (PRN), Dentists Concerned for Dentists (DCD), and the Health Professionals Group at the Mayo Clinic:

Upon receipt of your signed authorization form, HPSP will send the group facilitator a copy of your authorization and a letter asking the facilitator submit reports quarterly to HPSP documenting your participation.

For those attending other professional support group meetings, such as the Nurse Peer Support Network, or PSP (outside of Minneapolis):

Please use the Professional Support Group Attendance (PDF) form to document your meeting attendance.
Monthly Medication Logs*

Monthly Medication Logs (PDF) 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.