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:

Po’ailani, Inc
Intake Office
970 N. Kalaheo Avenue, Suite A102
Kailua, HI 96734

Or fax 808 262-0970

Screening Process

Your application is not considered complete until all documentation is received. Once the complete documentation packet is received, it will be screened by the Intake Specialist and Treatment Team. The program will notify you if your admission request is accepted or denied. Once accepted, you will be placed on the waitlist if bed space is not available. You will be required to contact the intake office periodically to check for bed space availability.

Thank you for your interest in the Po’ailani Dual Diagnosis Treatment Program. Please contact the Intake office at 808 262-2799 with any further questions.