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Order For Substance Abuse Assessment Form. This is a Maryland form and can be use in Circuit Court Statewide.
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Tags: Order For Substance Abuse Assessment, CM-15, Maryland Statewide, Circuit Court
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Civil No.:
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________________________
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Defendant
FOR
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v.
CIRCUIT COURT
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Plaintiff
IN THE
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ORDER FOR SUBSTANCE ABUSE ASSESSMENT
IT IS this
Court for
day of
County, Maryland, hereby
ORDERED that
,
2
by the Circuit
shall submit to a
Name of Person to be Tested
substance abuse assessment, to be conducted by:
Substance Abuse Testing Facility
Address
City
State
Zip Code
; and it is further
Telephone Number
ORDERED that the substance abuse assessment shall include the following services:
[ ]
Rapid Substance Abuse Assessment. The person referred to above shall submit
to psychometric testing and a clinical interview. No urinalysis will be conducted.
The testing facility shall submit the results of the rapid substance abuse assessment
in writing to the court; and it is further
[ ]
Urinalysis Screening Only. The person referred to above shall appear at the
offices of the substance abuse facility to provide a sample for urinalysis. The
testing facility shall report the results of that urinalysis in writing to the Court; and it
is further
[ ]
In-depth Substance Abuse Assessment. The person referred to above shall
submit to psychometric testing and a clinical interview. They shall also be required
to provide a sample for urinalysis. The testing facility shall report the results of the
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CM 15 - Revised 9 March 2000
substance abuse assessment and urinalysis results in writing to the court; and it is
further
ORDERED, that the fee for the substance abuse assessment shall be paid for in the
.
following manner:
JUDGE
Recommended by:
(Date)
NOTICE
This substance abuse assessment has been ordered solely for the purposes of litigation and
does not establish a therapeutic relationship between the testing facility and the subject of
the assessment. The results of the testing are not confidential and may be disclosed at trial
or in anticipation of trial.
cc:
Testing Facility
Address
City
State
Zip
Telephone
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CM 15 - Revised 9 March 2000
