This government document is issued by Drug and Alcohol Programs for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:ug3qpcrqbm4&q=https://www.ddap.pa.gov/Licensing/Documents/Recovery%2520House%2520Licensing/Consent%2520to%2520Residency%2520form.pdf&sa=U&ved=2ahUKEwjUouahl_GFAxXlg_0HHekfCNQ4ChAWegQIARAB&usg=AOvVaw06PjMXBMIP6M-X51Kn4b_D