To applicants to the George Hawkins Memorial Treatment Center:
In the links to the left, you will find our Client Residential Admission Form, Supplemental Questionnaire, Health Examination Report (Physical & Lab Work) and Personal Items to Bring for Admission. Please complete the forms and return to my office as soon as possible. The Health Examination Report needs to be completed by your physician or their designee.
Please have the following completed within 30 days to comply with program eligibility:
- Physical Examination
- Laboratory Results including
- Tuberculosis Test (T.B.)/PPD Skin Test*
- Hepatitis Profile*
*These tests must read negative in order to qualify for admission. Positive test results are handled as special circumstances and the client should contact both their Physician for immediate treatment and the Treatment Center for notification.
*All tests must remain current. No tests older than thirty (30) days will be accepted.
You may mail or fax your completed information to:
Memorial Treatment Center
10320 North Airport Road
Clinton, Oklahoma 73601
Our minimum admission criteria are:
- Prospective Client must be clean and sober at least 7 days before scheduled admission
- Prospective client must be discharged or released for at least thirty (30) days from other restrictive treatments such as incarceration, half-way houses, and mental or physical hospitalization; a statement must accompany the application stating that the client is stable and compliant with medications
- 18 years of age or older
- a valid Certificate of Degree of Indian Blood (CDIB)
REFERRALS from other Agencies:
In the event of a referral, the referring agency must:
- include a DISCHARGE SUMMARY/TREATMENT PLAN
- be responsible for transportation to and from our facility
An Alcohol and Drug Assessment is highly encouraged and, if readily available, have the results released to this Treatment Center.
All potential clients are responsible for contacting George Hawkins Memorial Treatment Center on a regular basis to maintain eligibility for admission. If I have not heard from you in 30 days, we will drop your name from the list and you will need to reapply for admission. On your scheduled admission date, Admission times are 8:30 AM to 11:00 AM and 1:00 PM to 3:00 PM only (No Exceptions). Do not send incomplete applications to me until all paperwork is ready, including your medical paperwork.