10-Hour Course Forms & Payment

Thank you for choosing Step Three, Inc. for your 10-Hour ADSAC class. Please complete the information below. Payment of $150 is required at the end.

From the Oklahoma Department of Mental Health and Substance Abuse Services: 

Each consumer has the right to be treated with respect and dignity. Furthermore: Each consumer shall retain all rights, benefits, and privileges guaranteed by law except those lost through due process of law.

Each consumer has the right to receive services suited to his or her condition in a safe, sanitary and humane treatment environment regardless of race, religion, gender, ethnicity, age, degree of disability, handicapping condition or sexual orientation. No consumer shall be neglected or sexually, physically, verbally, or otherwise abused.

Each consumer shall be provided with prompt, competent, and appropriate treatment; and an individualized treatment plan. A consumer shall participate in his or her treatment programs and may consent or refuse to consent to the proposed treatment. The right to consent or refuse to consent may be abridged for those consumers adjudged incompetent by a court of competent jurisdiction and in emergency situations as defined by law. 

Additionally, each consumer shall have the right to the following: Allow other individuals of the consumer's choice participate in the consumer's treatment and with the consumer's consent; To be free from unnecessary, inappropriate, or excessive treatment; To participate in consumer's own treatment planning; To receive treatment for co-occurring disorders if present; To not be subject to unnecessary, inappropriate, or unsafe termination from treatment; and To not be discharged for displaying symptoms of the consumer's disorder. Every consumer's record shall be treated in a confidential manner.No consumer shall be required to participate in any research project or medical experiment without his or her informed consent as defined by law. Refusal to participate shall not affect the services available to the consumer. A consumer shall have the right to assert grievances with respect to an alleged infringement on his or her rights.

 

Each consumer has the right to request the opinion of an outside medical or psychiatric consultant at his or her own expense or a right to an internal consultation upon request at no expense. No consumer shall be retaliated against or subjected to any adverse change of conditions or treatment because the consumer asserted his or her rights.

 

ODMHSAS: Office of Consumer Advocacy, E-Mail: AdvocacyDivision@odmhsas.org

 Local: (405) 248-9037 Toll Free: (866) 699-6605  Reach out Hotline: (800) 522-9054

 

My signature indicates I have read and understand my rights and have been offered a copy of this document.

Step Three, Inc.  shall meet the requirements of all applicable state and federal laws, rules, and regulations.  Patient records are considered confidential and will not be released to another individual or agency without your expressed written consent, except upon receipt of a legitimate subpoena, in the event of a valid medical emergency, to meet the requirements of state law that child/elderly abuse be reported or in the event you present an imminent danger to yourself or others.

The confidentiality of all ADSAC information and records (including all ADSAC participant and course records, shall be kept, recorded, released, maintained, and provided to requesting parties in accordance with all applicable state and federal laws. 

b) For the purposes of certification, all institutions, organizations and facilitators will abide by 42 CFR, Part 2 as required for covered entities protecting the confidential and privileged nature of information in compliance with state and federal law and which requires at a minimum: 

(1) all ADSAC course information, whether recorded or not, and all communications between institution and organization staff, facilitators and participant are both privileged and confidential and will not be released without the signed consent of the participant or the participant’s legally authorized representatives:

(2) the identity of a participant who has received or is receiving ADSAC services is both confidential and privileged and will not be released without the signed consent of the participant or the participant’s legally authorized representative;

(3) limiting access to ADSAC course and participant information to only those persons or agencies actively engaged in the treatment of the participant and to the minimum amount of information necessary to carry out the purpose for the release;

(4) a participant or the participant’s legally authorized representative may access the participant’s ADSAC court information;

(5) certain state and federal law exceptions to disclosure of ADSAC course information without the signed consent of the participant or the participant’s legally authorized representative exist and the facility will release information as required by those laws, and; 

(6) notifying a participant of his or her right to confidentiality in writing.

 All consumers have the right to assert grievances with respect to any alleged infringement on their rights. They have the right to request the opinion of an outside medical or psychiatric consultant at their own expense, or a right to an internal consultation upon request at no expense. No consumer will be retaliated against or subjected to any adverse change of conditions or treatment because they asserted their rights. As stated above, consumers have the right to voice grievances regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for person and/or property and will not be subjected to discrimination or reprisal for doing so.

If a consumer feels that they have a grievance, they can complete a grievance orally or in writing with Step Three, Inc. They have the right to seek a review thereof with the Director, Misti Luke. A memorandum of the grievance will also be made by the Director, Misti Luke. The grievance should specify any objections or disagreements which the consumer has of Step Three, Inc. Every attempt will be made to resolve the grievance. Should the grievance be resolved, a written report of the actions to alleviate the aggrieved will be provided to the aggrieved consumer. Should the aggrieved consumer not be satisfied with the resolution, the grievance will be forwarded to the Board of Directors by the Director, with staff recommendations for resolution. In any event, the recommended resolution will be provided to the aggrieved consumer within one week of receiving the written grievance. Contact information for the Board of Directors is posted in the lobby of the office.

Complaints may also be directed to the ODMHSAS Office of Consumer Advocacy 2000 N. Classen Blvd. Ste. E6000, Oklahoma City, OK 73106 

ODMHSAS: Office of Consumer Advocacy, E-Mail: AdvocacyDivision@odmhsas.org

Local: (405) 248-9037 Toll Free: (866) 699-6605  Reachout Hotline (800) 522-9054

My signature indicates I have read and understand my rights to file a grievance and have been offered a copy of this document. 

Helpful Information for Class
• All classes are held online using Zoom.
• Your class workbook and paperwork will be mailed to the address you provided.
• Please download the Zoom app to your phone before class.
• A strong and stable internet connection is required.
• You will receive a Zoom link from your ADSAC facilitator on the day of class.

To attend class, you must:
• Be seated upright with your camera on at all times.
• Be in a quiet location by yourself.
• Be fully clothed.
• Have your workbook, class paperwork, and something to write with ready before class begins.
• Ensure your phone or tablet is fully charged and has a working camera.
• Not attend class while driving or riding in a moving vehicle.

If you have any questions, please contact the office at (580) 584-6622.