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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