Narcotic Treatment Programs

Applications and Forms

Application for License Renewal - DHCS 4029
Narcotic Treatment Program Initial Application - DHCS 5014
Guarantor Agreement - DHCS 5020
Facility and Geographical Area - DHCS 5025
Staff Information - DHCS 5026
County Certification - DHCS 5027
Organizational Responsibility - DHCS 5031
Patient Death Report - DHCS 5048
Affiliated and Associated Acknowledgement - DHCS 5134
Application for Protocol Amendment - DHCS 5135

Submit all forms and supporting documents to:

Department of Health Care Services
      Counselor & Medication Assisted Treatment Section, MS2603
      PO BOX 997413
      Sacramento, CA 95899-7413

DHCSNTP@dhcs.ca.gov

Narcotic Treatment Program Licensure Fees

Narcotic Treatment Program Licensure Fees

Frequently Asked Questions

Narcotic Treatment Programs Initial Application
Medication Unit Application
Office Based Narcotic Treatment Networks Application

Last modified date: 12/6/2021 1:31 PM