Laserfiche WebLink
Attachment D <br /> �� WasBingtan State to Procedure CS-21 <br /> Department of Social <br /> &Health Services <br /> Transforming lives SAMPLE FORM <br /> OPIATE SUBSTUTITION TREATMENT PROGRAM <br /> COMMUNITY RELATIONS PLAN <br /> AGENCY NAME <br /> Agency Administrator: DATE: <br /> Mailing address: <br /> Telephone: E-Mail address <br /> Proposed Site location: <br /> This template is designed to comply with requirements in WAC 388-877B-0400 and-405,42 CFR Part 8.12, and <br /> CSAT Guidelines for the Accreditation of Opioid Treatment Programs. The plan is separated into three parts: <br /> • Part One—Initial Community Relations Plan <br /> The initial community relations plan must be completed before an application will be considered. It must be <br /> submitted with the application. <br /> • Part Two—On-Going Community Relations Plan <br /> The on-going community relations plan outlines the agency's proposed on-going community relations efforts <br /> after the facility has opened. It must be submitted with the application. <br /> • Part Three—On-Going Community Relations Concern Log <br /> The on-going community relations concern log is designed to document community concerns that may arise <br /> after the program is full operation and to use for future quality assurance data. <br /> The last section of the document contains resource material pertaining to certification and accreditation. <br /> File name: f:\shared\sections\cert\OTP\Provider Request Forms 2014+\OTP Comm Rel Plan-App D-1/5/17 <br /> Page 1 of 15 <br />