Forms

Aloha,

Hina Mauka specializes in treatment for diagnosed substance use disorders that include alcohol with an emphasis on behavioral health issues. In residential, Hina Mauka also provides services for high functioning individuals who have been diagnosed with co-occurring disorders (such as depression, PTSD, trauma, etc.), and limited co-morbidity physical health disorders. We treat the general population that primarily has addiction, as well as, low to moderate-risk, non-violent offenders. Also, we service a small number of people who are high functioning and have a psychiatric forensic case.

Hina Mauka has a continuum of care that includes a beautiful 48-bed residential, nestled in the Ko’olau mountains, day treatment, intensive outpatient, outpatient services, as well as, continuing care. We have family programs as well. Our primary treatment locations are Kaneohe and Waipahu. .

Please read the following carefully:

  • Residential beds are generally full however admissions are done daily. A waitlist is managed by a case manager who will contact you once a bed becomes available. To be on the waitlist you must complete all the required documentation (Screening Information Packet) and provide whatever additional documentation that may be required by our doctors given your personal circumstances.
  • Admittance to Hina Mauka programs requires a proper diagnosis according to DSM V and meet a designated placement set forth by the American Society of Addiction Medicine (ASAM) criteria for treatment.
  • Hina Mauka has limited medical support services, which means that persons presenting for treatment must be properly detoxed and medically stable before admission. People in treatment must be able to self-medicate and self-monitor medical conditions. For residential, Hina Mauka is not a medical facility nor has the capability to administer qualified emergency responses. We provide basic first aid and call 911. For outpatient, patients work with their own physicians for proper medical care.
  • First and foremost, Hina Mauka makes decisions based upon safety and functionality, whether the issue is behavioral, psychological or medical, and as such, reserves the right to not admit. Hina Mauka is an engaging, high functioning facility. If we are aware of other services that could fit your needs better than Hina Mauka, we refer to those services that we believe are more appropriate at this time.
  • There is no wait list for day treatment or outpatient services

Hina Mauka encourages you to complete our application on our website or in person at our facility and to provide applicable medical and/or psychiatric health reports before admission.

Aloha,

Hina Mauka Management

Screening Information Packet

Please read instruction sheet before completing forms. This packet is use to determine if you are eligible and appropriate for Hina Mauka services. Please follow the instruction sheet. Click to see more

It is important that you complete the entire packet. If you do not understand any of the questions, please have someone help you complete the form. Also complete the consents attached to ensure proper communication. Without the consents we cannot release any information to anyone. Missing information may only delay a timely response. Please fax to (808) 236-2626 for Kaneohe or (808) 671-7727 for the Waipahu office.

Pre-Trial Referral Form

This form is used for Department of Public Safety contract referrals from Pre-Trial Officers (PTO) to make contract referrals. Please use this form when making pre-trial/defendant referrals for treatment services. Accompany this referral with the appropriate consents listed below.

ADAD Privacy Notice

This notice describes how medical and health information about you may be used and disclosed and how you can get access to this information. Click to see more

Please read this notice carefully. Please complete when making a referral and fax to (808)236-2626 for Kaneohe or (808)671-7727 for the Waipahu office.

HIPAA Privacy Notice

Information regarding your health care, including payment for health care, is protected by federal law. Click to see more

Hina Mauka Recovery Center may not say to a person outside Hina Mauka that you attend the program, nor may Hina Mauka disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as described in this notice and is permitted by federal law. In the event that Protected Health Information (PHI) is covered by more stringent state or federal laws, Hina Mauka will abide by the stricter condition. Please complete when making a referral and fax to (808) 236-2626 for Kaneohe or (808) 671-7727 for the Waipahu office.

Consent: Referral/Family/Individual

Please complete this form if you have a probation/parole officer, pre-trial officer, intake worker, case manager, private physician, family or the like that you would like Hina Mauka to communicate with on your behalf. Click to see more

Please identify by writing your initials next the information you would like to disclose. Please do not forget to sign the consent. Please complete when making a referral and fax to (808) 236-2626 for Kaneohe or (808) 671-7727 for the Waipahu office.

Consent Medical

Please complete this form if you have a medical and/or psychiatric condition that require consultation with your doctors. Click to see more

Please identify by writing your initials next the information you would like to disclose. Please do not forget to sign the consent. Please complete when making a referral and fax to (808) 236-2626 for Kaneohe or (808) 671-7727 for the Waipahu office.

What To Bring

If you are applying for residential treatment or are preparing for admission into residential treatment, please read this document. Click to see more

It gives clear instruction on what to bring and not to bring to residential and prepare for your stay.

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