Intake & Admission Process
The following documentation is required for admission into the Po’ailani Specialized Residential Treatment Program, and Outpatient Treatment Program:
- Po’ailani screening form – request one at 262-2799 or click here to download form
- Psychiatric Evaluation – current within 1 year, must include diagnosis of mental illness and addiction; click here to download form
- Medication List – signed by physician current within 2 weeks
- TB clearance- current within 1 year. An induration of 5mm or greater requires a chest x-ray
- Physical Exam- current within 1 year; click here to download form
- Diet order – required for Specialized Residential Treatment Program; click here to download form
- PHI consent packet – click here to download form
- Preferences for treatment is given to pregnant women and Intravenous drug users.
Adult Mental Health Division Consumers – Ask your case manager to submit a current LOCUS and master treatment service plan (MTSP) in addition to the other documents.
Incarcerated Clients – Ask your probation officer, parole officer or case manager to contact the program on your behalf.
Forward the complete documentation packet to:
970 N. Kalaheo Avenue, Suite A102
Kailua, HI 96734
Or fax 808 262-0970