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Specialized
Outpatient
Services
HOME
Court, ADSAC & DUI Programs
Intervention and Family Consultation
Assessments and Counseling
Contact Us
Referring Professionals
Help my loved one
I Want Help
Contact Info & Map
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Make a Referral
DHS Drug testing and treatment referrals to NorthCare Services must be submitted at
www.northcare.com
as they will no longer be processed on this site.
Referral Type
---select---
Court Related
Defense Attorney
DHS CW/TANF
DOC Probation and Parole
Doctor
OKC Municipal Court probation
OK County Criminal Court
OK County Drug Court
OK County Family Court
OK County Family Drug Court
OK County Juvenile Bureau
Parent
School Based Referral
All Others (not listed)
Client Information
Name
*
First
Last
Gender
*
Male
Female
Services of Name
DOB
*
Phone
*
Court Case # (JD, CM, CF)
Level of Identified Risk
*
Low Risk - (Risk is minimal, Assessment and Early Intervention referral is suggested)
Medium Risk - (Risk is moderate, Assessment and Extended Outpatient referral is suggested)
High Risk - (Risk is extreme, Assessment and Intensive Outpatient referral with additional family services is suggested)
Referral Source Information
Name
*
First
Last
Agency
*
Email
*
Phone
*
Fax
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Intervention, Counseling and Treatment Options
Juvenile or Adult
*
Adult
Juvenile
Intervention Services
Structured Family Intervention (Adult)
Structured Family Intervention (Adolescent)
Executive Style (Impaired Professional) Intervention
Case Management
Family Advice and Consultation
Continuing Care (Relapse Prevention)
Screening And Assessments Services
CBT Assessment
Criminal Court Substance Abuse Evaluation
DHS CW Substance Abuse Evaluation
DUI (ADSAC) Assessment
DOT (SAP) and Employment Substance Abuse Assessment
Family Court Substance Abuse Evaluation
Substance Abuse Evaluation
DUI Services
10 Hour ADSAC (DUI School)
24 Hour ADSAC (DUI School)
DUI Outpatient Programs (6 - Week Program)
DUI Outpatient Programs (12 - Week Program)
Relapse Prevention/Aftercare Programs- 6-week DUI Aftercare Program
Court Related/Probation Treatment Services
(BADD) - Basic Alcohol/Drug Diversion - (12 week First Time Alcohol/Drug Offender Program)
(DDDT) - Do Drugs Do Time - (16-24 week Repeat Drug Offender - Recidivism Reduction Program)
(RID) - Reducing Intoxicated Drivers - (16-24 week Repeat DUI Offender - Recidivism Reduction Program)
Substance Abuse and Co-Occurring
Aftercare (Relapse Prevention) Programs (6 - Week Program)
Aftercare (Relapse Prevention) Programs (12 - Week Program)
Early Intervention (Sub. Abuse Ed.) Program - 6-week substance abuse education program for adults and 12-week substance abuse education program for adolescents. Random Drug Testing provided (if UA referral form completed)
Outpatient Program – 12-16 week program (3-5 hours per week). Individual, group, family and substance abuse education services provided. Self-help meeting attendance and random drug testing is required.
Specialized Treatment Services
A2S Program- SOS's Alternative to Suspension (A2S) program addresses the needs of students who exhibit at risk behavior with drugs and/or alcohol which interferes with school and/or or violates schools district’s Code of Conduct and requires removing the students from school for a period of time.
Reason for Referral
Please type/list information you feel would be important to staff that would indicate why you are referring this client to SOS ( case History, Substance abuse indicators. Drug test results, Police reports Arrest history, Etc.)
Submit
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