George Hawkins Memorial Treatment Center

George Hawkins Memorial Treatment Center
10320 North Airport Road
Clinton, Oklahoma 73601

1-800-247-4612 ext. 32370

Local: 580-331-2370

Fax: 405-422-8282

To Whom It May Concern:
In this packet, you will find our Client Residential  Admission Packet. Please complete the forms and return to the Admission’s Office at the contact information above. In order to be placed on our waiting list, you will need to have all requested documents turned in before we place a Received date stamp on your application. The waiting list is based on a first come, first serve basis meaning the sooner we receive all the required documents, the sooner you are placed on our waiting list.

PLEASE NOTE THE FOLLOWING: You must have the following completed within 30 days to comply with
program eligibility:

• Physical Examination with any necessary medications filled for a 60-day period. Must have a
  doctor’s order for any daily over-the-counter medications such as Aleve, Ibuprofen, etc.
• Laboratory Results including: 1) Tuberculosis Test/ PPD Skin Test 2) Hepatitis Profile*

Lab tests must read negative in order to qualify for admission. Positive test results are handled as special circumstances. The client should contact both their physician for immediate treatment, and the Treatment Center for notification.

*No tests older than thirty (30) days will be accepted.

The George Hawkins Memorial Treatment Center is a non-medical center designed to facilitate the rehabilitation of the chemically dependent individual in a structured, therapeutic environment. Our combined services include, but are not limited to, individual/group therapy, alcohol/substance
abuse education, relapse prevention, spiritual/cultural activities, and 24-hour supervision.

Our minimum admission criteria: 1) Prospective client must be discharged or released for at least thirty (30) days from restricted environments such as prison, half-way houses, and mental/physical hospitalization; however, we will accept an immediate transfer from a county jail facility if judicial arrangements are made. 2) A statement must accompany the application stating that the client is stable and compliant with medications. 3) Must be at least 18 years of age or older. 4)
Must have a valid Certification Degree of Indian Blood. 5) Must provide immunization record.

Referrals from other agencies: In the event of a referral, the referring agency must: 1) Include a discharge summary/treatment plan. 2) Be responsible for transportation to/from our facility. 3) An alcohol and drug assessment is highly encouraged and results released to this Treatment Center.

All potential clients are responsible for contacting George Hawkins Memorial Treatment Center on a weekly basis to maintain eligibility for admission. If you fail to make contact in 30 days, you will be removed from the waiting list and will need to reapply for admission.

Irene Lime
Admissions Coordinator

Deliveries or Forgotten Items
No outside items will be accepted after admittance into the Treatment Center. You will need to bring everything you need for your 60-day staff at the

Phone Calls and Money Needed:
Clients have access to phone calls in Residential Treatment; however, phone privileges are not given until after the first two (2) full weeks of Residential Treatment.

George Hawkins Memorial Treatment Center provided all basic necessities, if client is unable to bring themselves. The only money needed will be for any special necessities the Treatment Center does not carry. The client can send the money with their case manager to request the items, and a receipt will be provided.

George Hawkins Memorial Treatment Center is a tobacco, e-cig, and vapor-free facility.

Please bring these items, and only these items:
o Twin sized linens
o Pillow, pillow case
o Twin sized bedding
o 2 towels/washcloths
o Alarm clock/no radio
o Personal hygiene (60-day supply)
o Toothbrush/Toothpaste
o Shampoo/Conditioner
o Body wash
o Deodorant
o Shaver/lotion/Q-tips
o Contact solution
o Shower shoes/house shoes
o Coat/jacket for season

You must have all up to date non-narcotic prescription medication in the original bottle with legible prescription label in your name. You must bring enough medication for your 60-day stay.

Unacceptable items:
o No tank tops, halter tops, short shorts, miniskirts, etc.
o No associated gang apparel/colors or garments displaying alcoholic/drug paraphernalia
o Pants that sit below the waist are unacceptable. No sagging
o No personal food or drinks allowed. Meals and snacks will be provided daily
o No weapons of any kind. This includes pocket knives and scissors
o No marijuana products – medical card or not
o No cell phones, tablets. or personal computers. If you do not have anyone to leave these items with, we do have a locked safe that we can keep your electronics in during your 60-day stay.

1. Client should be mobile. The facility meets the standard for handicap use, and the client must be able to follow the basic physical demands of our treatment program. The client must be physically and mentally capable of carrying out the basic detail duties that are rotated among clients each week.

2. The client must be eighteen (18) years of age or older. Married, engaged, cohabitating couples or close blood relatives including cousins will not be accepted concurrently.

3. Client must be willing to abide by program rules and regulations as well as consent to treatment. Failure to do so can result in dismissal from the program.

4. The Treatment Program must receive a client file from the previous social service or legal agency that includes discharge plans or a summary prior to the client being admitted. If the client is court ordered, court documents are required before admission.

5. Priority will be given to Native Americans who are enrolled tribal members to the Cheyenne and Arapaho Tribes.

6. Client or prior referring agency is responsible for transportation to and from our facility.

7. Each client will be required to have a full physical no more than thirty (30) days prior to admittance. A client with a mental health history must include a psychiatric report.

8. Client must be willing and able to participate in his/her treatment program.

A CONSENT/RELEASE OR INFORMATION MUST BE SIGNED BY YOUR ATTORNEY, JUDGE, PROBATION OFFICER BEFORE ANY INFORMATION REGARDING CLIENT IS SENT OUT. A BLANK RELEASED IS ATTACHED IN THIS APPLICATION PACK, OR CAN BE EMAILED BY CALLNG (580)331-2370. COPIES OF COURT PAPERS MUST BE TURNED IN AT TIME OF INTAKE.

DOWNLOAD THESE FORMS HERE

These forms are required with your application.  Once fully completed please send these to the George Hawkins Memorial Treatment Center.