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Fill Out Your 508 From Nc Dwi Services Form

The 508 From NC DWI Services form is a crucial document used in the assessment process for individuals involved in Driving While Intoxicated (DWI) cases. It serves to gather essential information regarding the client's clinical assessments, staff qualifications, and compliance with state regulations. To ensure proper processing, it's important for providers to complete this form accurately and timely.

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Article Structure

The 508 Form from North Carolina DWI Services plays a crucial role in documenting important aspects of DWI assessments and provider compliance. This form is essential for ensuring that licensed assessment providers meet state regulations while evaluating clients impacted by driving while intoxicated offenses. Among its multiple sections, the form addresses critical elements such as staff credentials, clinical assessment findings, and necessary documentation for completion. It not only requires providers to confirm their qualifications but also mandates evidence of clinical determinations and diagnoses, including DSM-IV codes for substance use disorders. Furthermore, it emphasizes the importance of client engagement by collecting signatures that acknowledge receipt of information about available DWI services and consent for communication with various agencies. The documentation process is tightly regulated, with specific deadlines for submitting Certificates of Completion, underscoring the need for adherence to policies that govern the e508 system. By meticulously outlining these requirements, the 508 Form seeks to ensure accountability and facilitate corrective measures when necessary, ultimately aiming to provide the best outcomes for individuals seeking to navigate the complexities of substance use assessments and treatment follow-up.

508 From Nc Dwi Services Example

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

Page 1

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

Page 2

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

Get 508 From Nc Dwi Services PDF Form

Form Characteristics

Fact Name	Description
Governing Laws	The form is governed by North Carolina Administrative Code 10A NCAC 27G.0104 and relevant Division Policies such as ACC002, 0108, and 1207.
Purpose	This form is used to assess clients involved in DWI (Driving While Impaired) scenarios and document findings to ensure compliance with state regulations.
Client Documentation	The provider must document areas deemed not met on the Review Findings and Exit Form, which is signed by the Provider.
Submission Timeline	The Certificate of Completion must be submitted within two weeks following the assessment date.
DWI Provider List	Clients must sign to confirm they received an updated list of all DWI Providers within their service area.
Client Consent	A separate Consent Form for Release of Information is required, ensuring clients know how their information will be communicated and reported.
Assessment Criteria	Clinical assessments must document conditions according to DSM-IV codes and ASAM Patient Criteria to validate diagnoses.
Noncompliance Corrections	Findings that require corrective actions must be clearly indicated in the comments section, leading to the creation of a Plan of Correction.

Guidelines on Utilizing 508 From Nc Dwi Services

Completing the 508 Form for NC DWI Services involves gathering specific client information, making necessary evaluations, and ensuring all required sections are filled out correctly. Following this guide will help simplify the process and ensure that all steps are taken to meet compliance standards.

Begin with the "Provider/Facility Name" and "Provider Code." Fill in the client’s name and record number.
Enter the "Assessment Date" and "Control Number." Ensure these dates are accurate.
If this assessment is noted as a Driving While License Revoked (DWLR) assessment, check the appropriate box.
In Section I, confirm that the staff is qualified to complete assessments as validated by NCSAPPB.
Move to Section II. Document the DSM-IV diagnosis, including any applicable codes for alcohol dependence or abuse. If there’s no diagnosis, mark "No Diagnosis."
Check for evidence of ASAM Patient Criteria and ensure the client's signature is present for list provision and consent for information release.
In Section III, document the prompt submission of the Certificate of Completion within two weeks of the assessment date and ensure the completion of all e508 processes by the provider.
Ensure evidence of any holds or rejects within the e508 system is documented and addressed.
Make sure the Certificate of Completion in the client file is signed, noting the date it was sent to the State Office.
For DWLR assessments, confirm the diagnosis is based on the clinical assessment and document treatment referrals as needed.
Finally, use the Comments section to note any areas requiring corrective action and provide additional details if necessary.

What You Should Know About This Form

What is the purpose of the 508 Form from NC DWI Services?

The 508 Form is used for assessing individuals who have been charged with a Driving While Impaired (DWI) offense in North Carolina. It serves as a monitoring tool to ensure that assessments are conducted according to established guidelines. This form is essential for documenting the clinical evaluation of a client and must be completed by qualified staff. It includes elements such as client diagnosis, consent for information release, and compliance with the e508 system for documentation.

What steps are involved in completing the 508 Form?

Completing the 508 Form involves several critical steps. First, qualified staff must verify their credentials to carry out the assessment, as stipulated by North Carolina regulations. Following the assessment, clinical criteria need to be documented, including any applicable DSM-IV diagnoses. Client signatures must be obtained for consent forms and for providing lists of DWI service providers. The form also requires documenting certificate submissions and management of the e508 system. If any areas fail to meet compliance, these must be recorded on the Review Findings and Exit Form.

How can I ensure compliance with the requirements outlined in the form?

To ensure compliance, it is essential to review and follow the requirements specified in the form carefully. Training for staff conducting assessments should include an understanding of the DSM-IV criteria, consent documentation, and the necessary completion of the e508 system. Providers should routinely check their submissions for accuracy and timeliness. If shortcomings are found, they must prepare and implement a Plan of Correction, which is documented on the Review Findings and Exit Form. Regular audits can also help identify and resolve compliance issues before they escalate.

What should I do if there is a non-compliance finding on my 508 Form?

If a non-compliance finding is noted, it is crucial to address the issues promptly. The form allows for comments that describe the finding, so clearly documenting the nature of the non-compliance is vital. A detailed Plan of Correction should be developed to address any deficiencies, including specific actions to remedy the situation. This plan must be acknowledged by the provider through their signature on the form and submitted according to the established timelines and procedures. Staying proactive in resolving these issues can prevent future complications and ensure smoother operation within DWI services.

Common mistakes

When filling out the 508 Form for NC DWI Services, individuals often make specific mistakes that can affect the process. One common error is failing to provide the client signature where required. The form clearly states that a client’s signature is mandatory on multiple sections, including acknowledgment of the updated list of DWI providers. Omitting this signature can cause delays in processing and may require re-submission.

Another mistake involves inaccuracies in the DSM-IV diagnosis section. Individuals sometimes miswrite or overlook this crucial detail. Each diagnosis must have the correct corresponding code. If this information is not completed accurately, it can lead to misunderstandings regarding the client’s treatment needs and eligibility for certain programs.

People also often neglect to document the Certificate of Completion submission date correctly. This date is important as it must show that the form was submitted within two weeks of the assessment date. An incorrect date can result in compliance issues and might lead to the impression that the assessment was not properly tracked.

Moreover, some providers forget to check for evidence regarding the management of the e508 system. Having no notes on how holds or rejects were resolved can paint a picture of poor oversight. This lack of documentation may lead to questions from auditors about the thoroughness of the assessment process.

Another common mistake is related to the diagnosis section for Driving While License Revoked (DWLR) assessments. Providers sometimes skip indicating whether the diagnosis is based on early, sustained, or partial remission. This essential information must be filled out to provide a clear view of the client's status and need for further treatment.

Finally, the failure to include appropriate comments where necessary can hinder the clarity of the form. For instance, any areas of noncompliance or corrective actions should be documented in the comments section. Leaving this portion blank may result in confusion and complicate the review process.

Documents used along the form

When dealing with the NC DWI Services, several additional forms and documents are important to ensure a smooth process. These forms complement the 508 Form and serve various purposes in the assessment and certification stages. Here’s a list of commonly used documents:

DWI Assessment Report: This report summarizes the individual’s assessment findings, diagnoses, and recommendations. It provides a detailed account of the evaluation process.
Consent Form for Release of Information: This form allows communication between different agencies by obtaining the client's consent to share findings and assessment results securely.
Plan of Correction (POC): In cases where deficiencies in the assessment process are noted, this plan outlines the steps the provider must take to address these issues.
Client Progress Notes: These notes track the client’s engagement and progress throughout their treatment, helping to monitor effectiveness and compliance with recommended actions.
Certificate of Completion: Once the required treatment or assessment is finished, this document certifies that the client has completed all necessary steps and is ready for review.
Review Findings and Exit Form: This form documents any assessment areas that were not met and outlines the required corrective actions for compliance.
Client Information Sheet: This sheet gathers essential details about the client, including personal information, history, and contact details, to facilitate better service delivery.
Auditor Review Form: Used by auditors to document their findings during the evaluation process, this form captures compliance levels and areas needing improvement.

Having these additional forms on hand can simplify the process and ensure all necessary documentation is complete. It's essential to stay organized and thorough while navigating these requirements.

Similar forms

The 508 Form from NC DWI Services is an important document used for assessing DWI cases. It shares similarities with several other legal forms. Here’s a list of documents that have similar purposes or structures:

DWI Assessment Form: Like the 508 Form, this document helps in evaluating a client's state of impairment or addiction. Both forms require thorough documentation and client consent for information sharing.
Certificate of Completion: This form acts as proof that a client has completed mandated treatment. Similar to the 508 Form, it also tracks compliance with treatment protocols and timelines for submission.
Consent for Release of Information Form: This document allows for the sharing of client information among agencies. Much like the 508 Form, it requires client signatures and clearly outlines the purpose for releasing sensitive information.
Plan of Correction (POC) Form: If issues arise from an assessment, a POC form outlines corrective actions needed. It closely follows the structured evaluation process seen in the 508 Form.
Documentation of Clinical Assessment: This form captures comprehensive details around a client's diagnosis and treatment recommendations. Just like the 508 Form, it must adhere to certain assessment guidelines and standards.
Review Findings and Exit Form: This document summarizes the results of a DWI case review. Similar to the 508 Form, it records findings and may lead to recommendations for further actions or corrections.
Substance Abuse Treatment Referral Form: When clients are referred to recovery programs, this form tracks their transition. It bears similarities to the 508 Form in documenting the client's treatment journey and necessary follow-up.

Dos and Don'ts

When filling out the 508 Form for NC DWI Services, there are specific actions to take and avoid. Adhering to these guidelines can help ensure accuracy and compliance.

Do double-check all entered information for accuracy before submission.
Do ensure that all required signatures, including the client's, are obtained.
Do submit the Certificate of Completion within the specified two-week timeframe.
Do indicate any exceptions and document non-compliance clearly in the comments section.

Don't leave any sections of the form incomplete; all fields must be addressed.
Don't submit the form without verifying that it aligns with the latest guidelines and policies.
Don't forget to keep a copy of the completed form for your records.
Don't misrepresent the client's information or provide inaccurate data.

Misconceptions

There are several common misconceptions about the 508 Form used for DWI Services in North Carolina. Here are four of them, along with explanations that clarify the truth.

Misconception 1: The 508 Form is only for individuals who have already been charged with a DWI.

This is not true. The 508 Form is also used for assessments prior to formal charges. It plays a crucial role in evaluating a person’s needs and determining appropriate interventions.

Misconception 2: Completing the 508 Form guarantees that a person will avoid penalties for a DWI.

The completion of the form does not prevent legal consequences. It serves as a tool for assessing the individual’s situation but does not offer legal immunity or affect the outcome of ongoing investigations.

Misconception 3: Only certified professionals can fill out the 508 Form.

While it is true that qualified staff must verify and complete certain sections, others can assist in gathering information. There are collaborative aspects to the assessment process, making it more comprehensive.

Misconception 4: The 508 Form is a one-time requirement.

In reality, this form may need updates or revisions. Ongoing assessments and any changes in a client's status can require additional documentation to ensure accuracy in reporting and effective treatment planning.

Key takeaways

Filling out the 508 Form for NC DWI Services is a process that demands attention to detail and adherence to the guidelines provided. Here are key takeaways regarding the form's completion and use:

Confirm that all required fields are completed accurately, including the client name, provider name, and assessment date.
Check documentation for the client's DSM-IV diagnosis, as this is crucial for appropriate assessment and treatment.
Ensure the client's signature is on the Consent Form for Release of Information, permitting communication among agencies.
Submit the Certificate of Completion within two weeks of the assessment date to maintain compliance with stated policies.
Address any holds or rejects in the e508 system swiftly; documenting these exceptions is critical.
In cases involving Driving While License Revoked (DWLR) assessments, use '9' where applicable and complete the pertinent sections accordingly.
Provide thorough comments regarding findings that necessitate corrective action; clarity will aid in the Plan of Correction process.
After completion, ensure that all signatures are collected and documentation is properly maintained within the client's file.

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