<p> COASTAL BEND REGIONAL Counties COURT RESIDENTIAL TREATMENT CENTER Aransas Bee 800 N. VINEYARD Live Oak SINTON, TEXAS 78387 McMullen (361) 364-4323 San Patricio</p><p>36th, 156th, 343rd District Courts</p><p>To: Community Supervision and Corrections Departments</p><p>Thank you for your interest in the Coastal Bend Regional Court Residential Treatment Facility. Enclosed is a Referral Packet Checklist for placement in our program.</p><p>Please submit the documents on the Referral Packet Checklist to review eligibility to our program. All information must be received to complete the screening process and placement. If your counties’ Community Supervision and Corrections Department does not provide our assessments listed in Referral Packet Checklist, we will consider similar screening tools comparable to our assessments. </p><p>If you have any questions or need further assistance in completing the Referral Packet Checklist, please contact me.</p><p>Sincerely,</p><p>Linda Diaz, Ph.D., LPC-S Director of Residential Services Coastal Bend Regional Court Residential Treatment Center 800 N. Vineyard Avenue Sinton, Texas 78387 Office: (361) 364-4323, Ext. 11 Fax: (361) 364-2768 Email: [email protected]</p><p>Form.012 09/11</p><p>36th, 156th, and 343rd JUDICIAL DISTRICTS COMMUNITY SUPERVISION AND CORRECTIONS DEPARTMENT</p><p>Coastal Bend Regional Court Residential Treatment Center Sinton, Texas</p><p>After the case has been staffed and determined appropriate for the CRTC, a packet will be prepared to include the following information. Separate packets to be submitted for the treatment and employment phase of the program.</p><p>CRTC If Not Applicable indicate NA in box Supervision Plan Current Photograph Referral Form Personal Data Sheet Judgment; Conditions; Orders Amending; MTRs; Orders Continuing CJAD Risk Needs Forms Texas Uniform Health Status Form Offense Report Criminal History Alcohol/Drug History (Dopers) Mortimer-Filkens (Questionnaire & Interview) – Alcohol Driving Offenses Only WRAT SASSI (for other than alcohol driving offenses) MMPI Psychological, SCS, PSI (if available) Urinalysis results TB Test results (skin tests may be submitted positive but admission screening will not be conducted until x-ray and a clean medical report are received) MUST ATTACH COPIES OF THE FOLLOWING: Drivers License or Texas ID or Birth Certificate Department Financial Status Report Social Security Card </p><p>Assigned Supervision Officer: Supervisor at Staffing: Date of Staffing: </p>