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Substance Abuse Services

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Provider Resources

Salt Lake County
Substance Abuse Services
Salt Lake County Government Center
2001 South State Street
#S2300
SLC, UT 84190-1001

Hours: 8 am - 5 pm
Phone:801 468-2009
Fax:801 468-2006
Email

The following forms are available in various formats.

To view or print out files in PDF (Portable Document Format), use the free Adobe "Acrobat Reader™"

Referral for Psychotropic Medication form added under Treatment

Prevention
National Outcome Measures			Word
RFP Results	Excel
Billing Matrix	Excel
Billing Matrix Completion Key	Excel
2007 Prevention Services Plan			Word
Prevention Guiding Principles		PDF
Blank Logic Model Worksheet			Word
Logic Model Example			Word

Treatment

Referral for Psychotropic Medication Form

FY08 Rate Table

FY08 Table Instructions

FY07 Admission/Discharge Form (Dr. Data Lite)

FY07 Treatment Rate Table

FY07 Rate Table Instructions

FY07 Activity Report

Key Data Items Change Form

FY2006 Treatment Services RFP Results

FY2005 Treatment Services Plan

Salt Lake County Government Center – 2001 South State Street Salt Lake City, UT 84190 – 801 468-3000