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This document is a request form for rehabilitation treatment, specifically targeting substance abuse for active duty members of the U.S. Coast Guard.
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How to fill out uscg rehabilitation treatment request

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How to fill out USCG Rehabilitation Treatment Request Form

01
Obtain the USCG Rehabilitation Treatment Request Form from the official USCG website or your local Coast Guard office.
02
Fill in your personal information, including name, rank, and service number.
03
Provide details about your medical condition, including diagnosis and any previous treatments.
04
Include information on the type of rehabilitation treatment being requested.
05
Submit the form to your commanding officer or the designated mental health provider as instructed.
06
Keep a copy of the completed form for your records.

Who needs USCG Rehabilitation Treatment Request Form?

01
Active duty Coast Guard members seeking rehabilitation for physical or mental health issues.
02
Reservists who require treatment related to service-connected conditions.
03
Members undergoing mandated treatment as part of their duty requirements.
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The USCG Rehabilitation Treatment Request Form is a document used by the United States Coast Guard to request assessment and treatment services for personnel with substance abuse issues.
The form must be filed by commanding officers, supervisors, or healthcare providers when they identify a Coast Guard member in need of rehabilitation for substance abuse or related issues.
To fill out the form, complete all required sections with accurate information regarding the member's personal details, the nature of the problem, previous treatment history, and recommended rehabilitation services.
The purpose of the form is to facilitate the proper evaluation and treatment of Coast Guard personnel struggling with substance abuse, ensuring they receive the necessary support and resources.
The form must report personal identification information of the member, substance abuse details, clinical evaluations, previous treatments, and specific recommendations for rehabilitation services.
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