• AYPH D&A Consortium Application

    AYPH D&A Consortium Application

    609 N. Main St., Ste. 105, Marion, SC (843)289-5061 Drug-Consortium@AtYourPlaceHealthcare.com
  • AYPH DRUG & ALCOHOL CONSORTIUM PROGRAM

  • DOT CONSORTIUM PACKAGE INCLUDES

    • Membership in DOT Random Testing Consortium or Individual Selections
    • Random Selections and Notifications Quarterly
    • Consultation and Administrative Support (One Time and On-Going Options)
    • Local and Out of Area Drug and Alcohol Collection Sties
    • Referrals to Substance Abuse Professional
    • Resource Center for Current Regulations and Agency Inspection Required Reports
    • DOT Alcohol and Drug Testing Employee Handbook
    • Drug Testing to Include Specimen Collection, Initial Lab Test and GC/MS Confirmation
    • Certified, Full Time MRO Reporting of Results via phone, email or fax.
  • FEE SCHEDULE

    Consortium Annual Membership  $249.99*                                                   

    Multiple Drivers $59.99/driver

     

    Consortium Annual Membership $199.99*

    (Owner Operator/Single Driver) 

     

    A Clearinghouse set-up fee may be required*

     

    Supervisor Training $75 - Online Version
    FMCSA Clearinghouse Registration Fee $25 - One-Time Fee Per Driver
    FMCSA Clearinghouse Query Program $10 - Per Driver
    Drug Test $75 - Fees May Vary Based On Each Clinic
    Alcohol Test $35 - Fees May Vary Based On Each Clinic
  • Select Program
  • Testing Fee Includes: 5 Panel DOT Drug Screen, Collection of Specimenn, Lab Testing with Confirmation, MRO Reporting, MIS Reports when required and/or requested, and Certified Random Selections - All DOT Approved.

    The testing services listed above will keep you in compliance with the DOT Drug and Alcohol Testing Regulations – 49 CFR Part 40 and the regulations of your operating administration.

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  • Status
  • At Your Place Healthcare LLC will act as an intermediary in transmitting the information from other service agents to the DER of the employer per Appendix F of the 49 CFR Part 40 Procedures.

  • Please select how you would like to receive correspondence
  • Are you an Owner Operator?
  • Are you currently enrolled in a Random Drug Testing Program?
  • Are you a seasonal company?
  • Company required DOT testing
  • Please note: All DOT employees must provide proof of negative drug test or previous Consortium enrollment before they will be enrolled in our Consortium Program. To use a previous drug test, it must have been taken within 30 days prior to joining the Consortium.

     

    Consortium Membership Fee (Multiple Drivers) $249.99
    1-10 DOT Employees/Drivers $59.99/driver
    Consortium Membership Fee  (Owner Operator/Single Driver) $199.99
    DOT Drug Testing $75 Urine Collection/Testing
    Clearinghouse Registration Fee $25
    Supervisor Training $75 required for all DOT companies except owner-operators
    Reinstatement Fee $75 DOT Drug test is required for reinstatement
       
  • Do you have more the three drivers
  • With my signature I hereby agree to participate in the At Your Place Healthcare LLC Consortium and further agree to abide by its rules, policies, and procedures. Upon receipt of my signed application and payment AYPH Drug Consortium will forward me a complete membership package, which will include proof of membership and AYPH Consortium rules and regulations.

     

  • DRIVER SNAPSHOT

    Complete one for each driver.
  • Date of Birth
     - -
  • Format: (000) 000-0000.
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  • Additional Driver
  • DRIVER SNAPSHOT

    Complete one for each driver
  • Date of Birth
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  • Format: (000) 000-0000.
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  • Additional Driver
  • DRIVER SNAPSHOT

    Complete one for each driver
  • Date of Birth
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  • Format: (000) 000-0000.
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  • Please submit driver's information 

    DRIVER SNAPSHOT

  • DRIVER INFO

  • Date of Birth
     - -
  • Format: (000) 000-0000.
  • Have you completed Return to Duty Test (Clearinghouse Step 5)*
  • Date*
     - -
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  • DOT RANDOM DRUG & ALCOHOL CONSORTIUM PROGRAM SERVICE AGREEMENT

  • At Your Place Healthcare LLC abides by all current Department of Transportation (DOT) Regulations regarding 49 CFR Part 40 of all DOT agencies. The goal of At Your Place Healthcare LLC is to provide dependable administrative survivors. The employer, however, is ultimately responsible for staying in compliance with the department of Transportation.

    Membership fees include all random draws and all administrative fees. Sperate fees are required for supervisor training, SALE Programs, Follow up testing, and its administration. At Your Place Healthcare LLC will act as an intermediary in transmitting the information from the other service agents to the DER of the employer per the Appendix F of the 49 CFR Part 40 procedures. We will retain all associated DOR required records during the service period and will provide these records upon request at no charge upon membership termination. Required records not received by this consortium will be the responsibility of the member (eg: MRO records sent to the enrolled not forwarded to us)

    Services Offered       

    DOT & NON-DOT Drug Testing Computer Generated Random Selections
    DOT Breathalyzer Alcohol Substance Abuse Professional Referral
    Certified MRO 48-Hours Result Notification
    Contracted Collection Sites  Supervisor Training & Education
     SAMSHA/NIDA Certified Lab Statistical Reporting Upon Request
  • At Your Place Healthcare LLC Policies:

    1. Information provided must be complete and accurate on the application. No false data may be knowingly submitted to At Your Place Healthcare LLC.

    2. The employer must implement a Substance Abuse Policy and instruct their employees according to the procedures in the employee handbook provided in the new member package.

    3. The employer understands that they are ultimately responsible for the validation, implementation and the consequences of their drug and alcohol testing program. The Employer further agrees that they understand the methods and policies of At Your Place Healthcare LLC.

    4. DOT’s main program may only enroll drivers operating under the Department of Transportation Federal Regulations.

    5. Non-DOT Employers may only enroll employees that they have determined to be legally eligible for such a program. Employers in the state of California have been given the disclosure regarding Supreme Court Ruling.

    6. Your company must remain current regarding amounts owed to At Your Place Healthcare LLC. A finance charge of 1.5% per month will be assessed for amounts 30 days passed due. Employers will be notified in writing with sufficient time as indicated on the notice. Failure to pay the indicated amount will result in termination.

    7. Insufficient Funds returned checks will be subject to a $29 Return Check Handling Charge.

    8. All random notifications must be responded to within the allotted time period. If we do not receive a response after a reasonable number of attempts have been made, we will report the result as “Failure to Test” Per DOT instructions.

    9. DOT drivers who show positive on any test authorized by At Your Place Healthcare LLC will be removed from the DOT pool until evaluated by a substance abuse professional as indicated in the DOT regulations. If the driver requests that the split specimen be tested, the employer is responsible for payment as indicated in the DOT Regulations. Any additional costs incurred for processing positive testing results are also the responsibility of the employer.

    10. Any company found to violate At Your Place Healthcare LLC policies or Department of Transpirations (DOT) Regulations 49 CFR Part 40 and any additional agency regulations, will be terminated without refund.

    Hold Harmless & Indemnification

    Company holds harmless and willfully indemnifies Consortium for any claims made by company, company’s employee, or former employee of company for the following claims: alleged improper, illegal, and/or unauthorized disclosure made by consortium to company or on company’s behalf pursuant to the requirements of this agreement.

    Company shall hold harmless and indemnify Consortium for any and all claims made by The Company’s employees with respect to any erroneous incorrect, and/or incomplete information. The Company is required to provide to the Consortium per services in this agreement.

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  • My Products*

    prevnext( X )
    Consortium Annual Membership Fee                                (Owner Operator/Single Driver). Consortium registration and initial urine drug screen
    Consortium Annual Membership Fee (Owner Operator/Single Driver)

    Consortium registration and initial urine drug screen

    $199.99$199.99
      
    Consortium Annual Membership Fee                                (Multiple Drivers). Consortium registration and initial urine drug test
    Consortium Annual Membership Fee (Multiple Drivers)

    Consortium registration  and initial urine drug test

    $249.99$249.99

    Item subtotal:$0.00$0.00
      
    Total
    $0.00$0.00

    Payment Methods

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