Amethyst Foundation, Inc.



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IDCMP Intake/Screening Requirements (He-A 507.01)

As mandated under New Hampshire Code of Administrative Rule, you are required to bring the following documents and payments to your scheduled intake/screening appointment.

1. ____ Current certified NH DMV record and current certified DMV record

from any state where you have previously had a DWI and /or where

you currently hold a driver’s license.

2. ____ Superior or District court order

3. ____ Documentation of chemical test results or documentation of the

refusal to submit to chemical tests

5. ____ A copy of the arrest report

6. ____ A copy of the arrest narrative

7. ____ Documentation of proof of completion of an Impaired Driver

Intervention Program if such a program has been completed within

the past five (5) years prior to current conviction

8. ____ $70.00 State Regulatory fee (certified check or money order) payable

to the "State of NH Treasurer")

9. ____ $75.00 Screening fee if scheduling a screening (payable to Amethyst

Foundation)

10. ____ $200.00 Evaluation fee if scheduling an evaluation (payable to

Amethyst Foundation)

04/2018

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