№ lp_1_35572
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This is an intake and assessment form used for evaluating clients with substance use disorder, gathering relevant health, social, and medical history, and identifying treatment needs.
Note:
Year
Theme:
Substance Use Disorder Assessment
Document Type:
Intake Form
Price: 8 / 10 USD
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2020-2025
Region / City:
Oklahoma
Theme:
Substance Use Disorder (SUD), Medicaid Expansion, Mental Health
Document Type:
State Demonstration Report
Organ / Institution:
Oklahoma State Government
Author:
Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS)
Target Audience:
State policymakers, health service providers, Medicaid beneficiaries
Period of Validity:
12/22/2020 - 12/31/2025
Approval Date:
12/22/2020
Amendment Date:
Not specified
Year:
2020-2030
Region / city:
Global
Theme:
Military technology, Special Operations Forces
Document type:
Strategic Plan
Organization:
United States Special Operations Command (USSOCOM)
Author:
USSOCOM Acquisition, Technology, and Logistics Center’s Science and Technology Directorate
Target audience:
Military professionals, defense contractors, researchers
Period of validity:
2020-2030
Approval date:
Not specified
Date of changes:
Not specified
Note:
Year
Subject:
Behavioral Health Assessment
Document Type:
Form
Institution:
ACBH
Note:
Year
Year:
2026
Region / City:
Connecticut
Topic:
Healthcare, Substance Use Disorder Services
Document Type:
Addendum to Agreement
Organization / Institution:
Connecticut Department of Social Services
Author:
Connecticut Department of Social Services
Target Audience:
Providers in the Connecticut Medical Assistance Program (CMAP)
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2023
Region / City:
Alameda County
Topic:
Health Insurance Technician Assistance
Document Type:
Instructional
Organization / Institution:
Alameda County
Author:
Unknown
Target Audience:
SUD Providers
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2026
Region / City:
Not specified
Subject:
Substance Use Disorder quality review and compliance
Document Type:
Checklist / Reference list
Organization / Institution:
BHCS
Author:
Not specified
Target Audience:
Healthcare providers attending CQRT
Applicable Period:
Ongoing / per meeting
Required Forms:
BHCS Authorization Form, SUD Compliance Tool, Health Questionnaire, Medical Necessity Forms, Physical Exam Documentation, ASAMs, Treatment Plans / Updates, Progress Notes, Group Sign-in Sheets, RES UM Authorization Forms
Instructions:
Paper versions with signatures must be brought to CQRT
Year:
2026
Region/City:
United States, California
Subject:
Substance Use Disorder (SUD) Program Compliance
Document Type:
Clinical Compliance Checklist
Organization:
Behavioral Health Care Services (BHCS)
Author:
BHCS Quality Assurance Team
Target Audience:
Clinicians, SUD Counselors, LPHA
Next Review Date:
2026-04-01
Assessment Period:
Ongoing per client admission and treatment plan
Clinical Components:
Informed consent, medical necessity, intake assessment, treatment plan, progress notes, discharge planning
Service Types:
Residential, outpatient, perinatal, and other SUD programs
Documentation Requirements:
Signatures, dates, clinical rationale, ICD-10/DSM-5 codes, progress notes, group notes
Year:
2026
Region:
United States
Document Type:
Clinical Compliance Checklist
Organization:
Behavioral Health Care Services (BHCS)
Intended Audience:
Clinical reviewers, SUD counselors, LPHA
Service Type:
Substance Use Disorder (SUD) programs
Review Frequency:
Daily notes, 14-day minimum for clinical review, 30-day minimum for quality review
Authorization Period:
Specified per SUD program type
Required Documentation:
Intake assessments, client plans, progress notes, group notes, medical records
Assessment Criteria:
Medical necessity, documentation completeness, service delivery, coordination of care, compliance with regulatory standards
Reviewer Signatures:
Supervisor and CQRT reviewer required
Year:
2025
Region / City:
Massachusetts, Boston
Topic:
Healthcare, Opioid Use Disorder, Long-Term Care
Document Type:
Memorandum
Organization / Institution:
Department of Public Health
Author:
Teryl Smith, RN, MPH
Target Audience:
Long-Term Care Facility Administrators
Period of Validity:
August 14, 2025
Approval Date:
August 14, 2025
Date of Changes:
August 14, 2025
Year:
2026
Region:
North East Essex, UK
Subject:
Neurodevelopmental disorders in children and young people
Document type:
Guidance booklet
Organization:
Suffolk and North East Essex Integrated Care Board; East Suffolk North East Essex Foundation Trust (ESNEFT)
Audience:
Parents and carers of children and young people
Content focus:
Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), neurodiversity, diagnostic pathway, support services
Purpose:
Explanation of assessment and diagnostic pathway for neurodevelopmental disorders
Year:
2021
Region / city:
United States
Topic:
Stimulant use disorder, clinical guidelines
Document Type:
Clinical Practice Guideline
Organization / Institution:
ASAM, AAAP
Author:
Not specified
Target Audience:
Healthcare professionals, addiction specialists
Effective Period:
Not specified
Approval Date:
2021
Date of Revisions:
Not specified
Year:
2026
Region / State:
Idaho, USA
Document Type:
Program Description
Organization:
BPA Health
Target Audience:
Clients with substance use disorders, provider networks, stakeholders
Scope of Services:
Outpatient, residential, social detoxification, community-based settings, Recovery Support Services
Funding Sources:
Federal block grants, state funding, discretionary grants
Quality Focus Areas:
Accessibility, Appropriateness, Timeliness, Continuity, Effectiveness, Efficiency, Safety, Client/Provider Relationships
Compliance:
Contractor and provider regulatory and contractual adherence
Year:
2020-2025
Region / City:
Oklahoma
Theme:
Substance Use Disorder (SUD), Medicaid Expansion, Mental Health
Document Type:
State Demonstration Report
Organ / Institution:
Oklahoma State Government
Author:
Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS)
Target Audience:
State policymakers, health service providers, Medicaid beneficiaries
Period of Validity:
12/22/2020 - 12/31/2025
Approval Date:
12/22/2020
Amendment Date:
Not specified
Year:
2022
Region / City:
Massachusetts
Subject:
Opioid Use Disorder, Long-Term Care Facilities
Document Type:
Memorandum
Agency:
Massachusetts Executive Office of Health and Human Services, Department of Public Health
Author:
Elizabeth Kelley, MPH, MBA, Director Bureau of Health Care Safety and Quality
Target Audience:
Long-Term Care Facility Administrators
Period of Validity:
September 12, 2022
Approval Date:
September 12, 2022
Note:
Year
Region / City:
Jacksonville
Subject:
Autism Spectrum Disorder, Emergency Response
Document Type:
Information Sheet
Agency / Institution:
Jacksonville Police and Fire Departments
Target Audience:
Individuals with Autism Spectrum Disorder, First Responders, Emergency Personnel
Year:
2008
Region / City:
N/A
Theme:
Eating Disorders
Document Type:
Questionnaire
Organization / Institution:
N/A
Author:
Fairburn, Beglin
Target Audience:
Individuals experiencing eating disorders or professionals assessing eating disorders
Period of validity:
N/A
Approval Date:
N/A
Date of revisions:
N/A
Document type:
Psychological report section
Purpose:
Application to SPED school offering National Curriculum for students with Autism Spectrum Disorder
Target population:
Children with Autism Spectrum Disorder
Intended users:
Registered Educational or Clinical psychologists
Governing body reference:
Ministry of Education, Singapore
Professional guidelines referenced:
Professional Practice Guidelines for the Psycho-educational Assessment & Placement of Students with Special Educational Needs (2018)
Clinical guidelines referenced:
Clinical Practice Guidelines on Autism Spectrum Disorder in Children and Adolescents (2023)
Jurisdiction:
Singapore
Assessment instruments referenced:
Singapore Ability Scales
Validity period of assessment:
Within 2 years from date of application
Educational context:
Special Education (SPED)
Content scope:
Psycho-educational assessment, diagnosis, developmental, educational, intervention, and medical history
Authorship requirements:
Psychologists listed in the Singapore Register of Psychologists