Name - Client first name Client last name
Today's Date: Date
Overnight requests should be very limited and approved by the House Leader/Asst Leader at least 24 hours in advance. You must be in compliance with all the house rules before approved and you must have been in the home for at least a minimum of 14 days.
**if you've tested positive returning from an overnight, or for any random UA/BA, you must have 60 continuous days of sobriety before you will be authorized to go on an overnight.
My initials here confirm that I am in compliance with all above and I've gotten approval for this overnight. Initials Text field
If you are self-pay for your bed fee, no extra fees are due.
If you are with a County funded IOP that allows overnight passes (ECS does NOT), OR you are Medi-Cal funded Recuperative Care (RC)/Short Term Post (STP), you will need to pay Empowering Potential Housing $50 per night for your missing nights in advance of leaving.
We are not able to charge a head-in-bed or fee to the program or to Medi-Cal if you are gone for a night. Even if you are in the hospital. If you are gone to the hospital overnight while on RC/STP, most times we will need a new authorization from your insurance to readmit.
We prefer Zelle or Venmo to empoweringpotentialhousing@gmail.com for payment in advance of any planned overnights.
If you need help paying, please call Rachel at 619-500-3987 to make arrangements.
Missing Night(s):
Date