Legal Notice

Name of company

John Archer Dandridge Ltd. P.C.

Registered office

19415 W. McNichols Suite T

Detroit, Michigan 48219

Contact details

313 969-8817

Regulatory authority

Welcome to John Archer Dandridge Ltd., P.C. (JAD). This service is provided to address the substance abuse issues that affect public safety.

JAD Ltd, P.C. provides comprehensive case management services that include Substance Abuse Professional (SAP) evaluations, recommendations for treatment and follow-up testing and aftercare monitoring (when requested).  If it is not your employer’s policy to pay for SAP evaluation services, you are financially responsible to do so. All expenses that arise from treatment and/or education, as recommended by the SAP, will be your financial responsibility.

John Dandridge and the service agents and/or entities listed below must disclose to one another and receive from one pertinent and relevant information regarding:

1.   My violation of DOT regulations (prohibited conducts)

2.    My drug and/or alcohol test results

3.    The Substance Abuse Professional’s (SAP) synopsis of my treatment plan

4.     The SAP’s assessment evaluation and treatment plan

5.     Diagnostic information, where applicable

6.     Treatment progress reports

7.     Program completion information, including discharge summary, if applicable

8.     Program involvement dates, attendance reports

9.     Other relevant information as it pertains to my return-to-duty process

SAP:    John Dandridge

Treatment/Education Provider:

EAP:

DER (Designated Employer Representative):

MRO (Medical Review Officer):

C/TPA:

The purpose of the exchange of information is to comply with DOT requirements that must be met before I may take a Return to Duty drug and/or alcohol test, prior to being considered by my employer for returning to the performance of safety-sensitive functions under DOT regulations.

I understand that my records are protected under the federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2, and cannot be disclosed without my written consent unless other wise required by law, or provided for under the DOT regulations, and as specified below.

I understand that communication between service agents/entities is required under U.S Department of Transportation rules and regulations, and is permitted without my authorization.  In addition, the regulations permit the SAP to send required reports to my employer, without my authorization. However, in order for the SAP to provide reports to employers other than my current employer, including future employers, the SAP must obtain my written authorization.

Lawful release of records is permitted under the following conditions:  if you pose a clear and imminent danger to self or others, if there is known or suspected child abuse or neglect, if medical records are court ordered by a judge compelling disclosure, when the SAP seeks medical or legal consultation, if the SAP is to make case records available, on request, to DOT agency representatives and/or representatives of the National Transportation Safety Board in an accident investigation