Template Control Page. Substance Misuse Newham Template Guide. Substance Misuse Newham. Date September 2015 DOCUMENT MANAGEMENT REVISION HISTORY

Alcohol Misuse Tower Hamlets Template Guide 2016

Alcohol Misuse Tower Hamlets Template Guide 2016 1 Template Control Page Alcohol Misuse Tower Hamlets Template Guide Title Alcohol misuse Tower Hamlets Auth CEG Version 2 Descript Suppts Tower Hamlets

GLP-1 Initiation and Follow Up. Version Date Summary of Changes 1.0 April 2013 This is a new template

Template Control Page GLP-1 Initiation and Follow Up Template Guide Title GLP-1 Initiation and Follow Up Author CEG Version 1.0 Status Active DOCUMENT MANAGEMENT REVISION HISTORY Version Date Summary of

Pocket Card SBIRT Side 1 and 2

Pocket Card SBIRT Side 1 and 2 Pocket Card SBIRT Health Effects of Substance Abuse Alcohol Use Disorders Identification test (AUDIT) NAME: Date: The following questions concern information about your alcohol

SBIRT Screening and Brief Assessment Questionnaires

SBIRT Screening and Brief Assessment Questionnaires 1. Brief Screens: NIAAA quantity and frequency Single alcohol screening question) Single drug screening question Conjoint screening questions 2. Full

Chapter 7. Screening and Assessment

Chapter 7 Screening and Assessment Screening And Assessment Starting the dialogue and begin relationship Each are sizing each other up Information gathering Listening to their story Asking the questions

NHS FORTH VALLEY LOCAL ENHANCED SERVICE (2010) General Practitioner Prescribing Service (GPPS) Opiate Assisted Treatment Service Specification

NHS FORTH VALLEY LOCAL ENHANCED SERVICE (2010) Rationale General Practitioner Prescribing Service (GPPS) Opiate Assisted Treatment Service Specification Aims It is the responsibility of general practitioners

Stafford Borough Council & South Staffordshire LPC - Alcohol Screening, Brief Intervention, AUDIT and Follow-up Service

Stafford Borough Council & South Staffordshire LPC - Alcohol Screening, Brief Intervention, AUDIT and Follow-up Service Background Alcohol misuse is recognised nationally as being of critical concern in

Alcohol advice and local support

Alcohol advice and local support This information leaflet has been given to you by your doctor or nurse to provide further information and advice about alcohol and where you can get local support. How

Statistics from the Northern Ireland Drug Misuse Database: 1 April March 2011

Statistics from the Northern Ireland Drug Misuse Database: 1 April 2010 31 March 2011 This bulletin summarises information on people presenting to services with problem drug misuse and relates to the 12-month

Guidelines For Services Providing Injecting Equipment

Guidelines For Services Providing Injecting Equipment Best Practice Recommendations For Commissioners and Injecting Equipment Provision (IEP) Services in Scotland (Scottish Government 2010) January 2014

Seek, Test, Treat and Retain for Criminal Justice Populations: Data Harmonization Measure

Seek, Test, Treat and Retain for Criminal Justice Populations: Measure Drug and Alcohol Use Drug and Alcohol Measure References: 1) Adapted from: Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B. & Monteiro,

Substance use and misuse

An open learning programme for pharmacists and pharmacy technicians Substance use and misuse Educational solutions for the NHS pharmacy workforce DLP 160 Contents iii About CPPE open learning programmes

Statistics from the Northern Ireland Drug Misuse Database: 1 April March 2012

Statistics from the Northern Ireland Drug Misuse Database: 1 April 2011 31 March 2012 This bulletin summarises information on people presenting to services with problem drug misuse and relates to the 12-month

Dual Diagnosis Street Team

Dual Diagnosis Street Team DDST n Cambridgeshire and Peterborough NHS Foundation Trust We work with the homeless who are experiencing mental health and substance issues A member of Cambridge University

Service Specification: Bristol and South Gloucestershire Specialist Substance Misuse Treatment Service January 2016

This specification is an annex to the Service Specification for the provision of Child and Adolescent Mental Health Services. It must be read along with the overarching specification which applies to all

DrinkCheck. Is your drinking okay?

DrinkCheck Is your drinking okay? WHAT SORT OF DRINKER ARE YOU? Test your drinking... DrinkCheck can help you find out more about your drinking. Just complete the questionnaire and add up your score. Then

New Patient Check City and Hackney

Template Control Page New Patient Check City and HackneyTemplate Guide Title New Patient Check City and Hackney Author CEG Status Active Date September 2016 DOCUMENT MANAGEMENT REVISION HISTORY Version

BROMLEY JOINT STRATEGIC NEEDS ASSESSMENT Substance misuse is the harmful use of substances (such as drugs and alcohol) for non-medical purposes.

13. Substance Misuse Introduction Substance misuse is the harmful use of substances (such as drugs and alcohol) for non-medical purposes. The term substance misuse often refers to illegal drugs, but, some

Chapter 7. Screening and Assessment

Chapter 7 Screening and Assessment Screening And Assessment Starting the dialogue and begin relationship Each are sizing each other up Information gathering Listening to their story Asking the questions

QuADS Organisational Standards and Professional Competencies in needle exchange

QuADS Organisational Standards and Professional Competencies in needle exchange N This briefing paper was funded by the Department of Health as part of their 'Making Harm Reduction Work' initiative. DrugScope/Department

Addictive Disorders Assessment Form

Addictive Disorders Assessment Form Thorpe Recovery Centre Telephone: 780.875.8890 Fax: 780.875.2161 Email: info@thorperecoverycentre.org CLIENT INFORMATION First Name Middle Name Last Name Phone Number

Managing drug misuse in pregnancy and beyond

Managing drug misuse in pregnancy and beyond Dr Emily Finch Clinical Director Addictions CAG, South London and Maudsley Foundation NHS Trust Rachel Evans, Adfam 1 / Aims of the session Update on management

REFERRAL SOURCE GUIDELINES. Listed below is a general outline of the referral, interview and intake process at Last Door Recovery Centre.

REFERRAL SOURCE GUIDELINES Listed below is a general outline of the referral, interview and intake process at Last Door Recovery Centre. 1. Contact Last Door Recovery Centre at 1 888 525 9771 to determine

Pharmacy Needle and Syringe Programme. Enhanced Contract

Pharmacy Needle and Syringe Programme Enhanced Contract 1 st April 2012 31 st March 2013 Signed on behalf of LPC Signed on behalf of CRI Signed on behalf of Turning Point Signed on behalf of KCA Signed

PH52. Audit tool for the implementation of. NICE public health guidance 52 Needle and syringe programmes

PH52 Audit tool for the implementation of NICE public health guidance 52 Needle and syringe programmes Introduction This audit tool has been developed to help you audit implementation of, and compliance

The alcohol treatment needs of violent and non-violent prisoners

Practice The alcohol treatment needs of violent and non-violent prisoners N Bowes A Sutton S Jenkins FORENSIC PSYCHOLOGICAL SERVICES, NOMS CYMRU, HMP CARDIFF J McMurran INSTITUTE OF MENTAL HEALTH, UNIVERSITY

EVALUATION OF AN INTERRELATED TIERED INTERVENTION TO REDUCE HAZARDOUS AND HARMFUL DRINKING

EVALUATION OF AN INTERRELATED TIERED INTERVENTION TO REDUCE HAZARDOUS AND HARMFUL DRINKING Ciara Close, Research Fellow, Centre for Public Health, QUB ALCOHOL MISUSE Alcohol misuse means drinking excessively

Service User Information Leaflet

Service User Information Leaflet North Tyneside Recovery Partnership (NTRP) The North Tyneside Recovery Partnership (NTRP) is a dedicated service for anyone in North Tyneside experiencing problems with

APPLICATION FORM NAME:

APPLICATION FORM NAME: Application Date: Birthdate: SIN#: Requested Date for Residency: Present Address: Phone #: How long at this address? MSP #: Marital Status: Employment Status: Education: Emergency

Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April March 2012

Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2011 31 March 2012 4th October 2012 Vol. 1: The Numbers Executive Summary Of the 197,110 clients aged 18 and over in treatment

CABINET PROCURING A SUBSTANCE MISUSE & COMMUNITY TREATMENT SERVICE IN RUTLAND

CABINET Report No: 105/2017 PUBLIC REPORT 16 May 2017 PROCURING A SUBSTANCE MISUSE & COMMUNITY TREATMENT SERVICE IN RUTLAND Report of the Director of Public Health Strategic Aim: Safeguarding Key Decision:

TE WHARE ORANGA NGAKAU REFERRAL FORM

TE WHARE ORANGA NGAKAU REFERRAL FORM REFERRER INFORMATION REFERRAL FROM: NAME: POSITION: POST CODE: PHONE NO: FAX NO: CLIENT INFORMATION CLIENTS FULL NAME: DATE OF BIRTH: PHONE NO: POST CODE: ETHNIC GROUP:

Albany County Coordinated Entry Assessment version 12, 11/29/16

Referral Completed by: PRE-SCREENING INFORMATION FOR SHELTER REFERRAL 1. First Name Last Name Date/Time: Other names (including nicknames): 2. Has client previously completed an application for assistance

APPLICATION/ASSESSMENT FORM FOR SUPPORTED ACCOMMODATION AT TACT FRHP

APPLICATION/ASSESSMENT FORM FOR SUPPORTED ACCOMMODATION AT TACT FRHP These questions are not an examination you have to pass, we merely need to know about you so we can be sure we can offer you the support

Co-existing Mental Health and Alcohol and Drug Problems (Dual Diagnosis) Strategy

Problems (Dual Diagnosis) Strategy 2016-18 Board library reference Document auth Assured by Review cycle P154 Consultant Nurse f Dual Disder Quality and Standards Committee 3 Years This document is version

SMART Wokingham Young persons Screening and Referral Form

SMART Wokingham Young persons Screening and Referral Form Referral Source Date: Name of worker: Contact number: Referring Agency: Email address: Client Information Surname First Name Title Previous Name

DATA CO ORDINATION OVERVIEW OF DRUG MISUSE 2012

DATA CO ORDINATION OVERVIEW OF DRUG MISUSE 2012 FOREWORD I am delighted to present this 13 th edition of the Data Co-ordination Overview of Drug Misuse in the South East region. The South East covers the

If so, when: Demographic Information Male Transgender Height: Weight: Massachusetts Resident? Primary Language: Are you currently homeless?

Application Form rev. 9/09 Jeremiah's Inn P.O. Box 30035 1059 Main St., Worcester, MA 01603-0035 FAX 508.793.9568 Phone 508.755.6403 Last Name: Suffix: First Name: Middle Initial: Alias: Referral Information

DrinkCheck Is your drinking okay?

DrinkCheck Is your drinking okay? What so of drin are you DrinkCheck can help you about your drinking. Just questionnaire and add u Then find out what it mea *DrinkCheck is for people 18 years or older.

Chad Sabora, BS, MS, JD Missouri Network for Opiate Reform and Recovery. Drug Policy, Harm Reduction, and What s Next

Chad Sabora, BS, MS, JD Missouri Network for Opiate Reform and Recovery Drug Policy, Harm Reduction, and What s Next The start or lack thereof of Drug Policy in the United States The Harrison Narcotics

MINOR CLIENT HISTORY

MINOR CLIENT HISTORY CLIENT NAME: DATE: FAMILY & SOCIAL BACKGROUND: Please list and describe your child s or teen s current family members (immediate, extended, adopted, etc.) NAME RELATIONSHIP AGE OCCUPATION

NIDA Quick Screen V1.0F1

NIDA Quick Screen V1.0F1 Name:... Sex ( ) F ( ) M Age... Interviewer... Date.../.../... Introduction (Please read to patient) Hi, I m, nice to meet you. If it s okay with you, I d like to ask you a few

Vivitrol Drug Court and Medication Assisted Treatment

Vivitrol Drug Court and Medication Assisted Treatment Amy Black, CNP and Judge Fred Moses Court program Self-starters Mission Statement To provide court-managed, medically assisted drug intervention treatment

Handbook for Drug Court Participants

Handbook for Drug Court Participants Important names and numbers: My Attorney: Phone # My Probation Officer: Name: Phone # My Treatment Program: Phone # Drop Line # Your Assigned color is Visit the web

APPLICATION FOR ADMISSION (PLEASE PRINT CLEARLY)

1317 w. Washington Blvd. Fort Wayne, In. 46802 260-424-2341 APPLICATION FOR ADMISSION (PLEASE PRINT CLEARLY) NAME: _ FIRST MI LAST DATE OF BIRTH: / / AGE: SOCIAL SECURITY NUMBER: LAST OR CURRENT ADDRESS:

Addiction and Substance misuse pathways

Addiction and Substance misuse pathways Gordon Morse Chief Medical Officer Turning Point UK Gordon Morse statement of interests Sole employer Turning Point Some unpaid advisory work to the Hepatitis C

Drug problems in Dublin

Symposium Gerald Bury MRCPI, MRCGP Lecturer in General Practice, Royal College of Surgeons in Ireland, Department of General Practice, Dublin, Ireland Drug problems in Dublin Despite some evidence of a

A handbook for people who have injected drugs

A handbook for people who have injected drugs Introduction This handbook has been written for current and ex-drug injectors. It gives information and advice about the hep C virus, and the tests you can

Urban Village Medical Practice Service Review An integrated model for high quality healthcare for homeless people in Manchester

An integrated model for high quality healthcare for homeless people in Manchester Urban Village Medical Practice Urban Village Medical Practice (UVMP) is a GP practice based at Ancoats Primary Care Centre

1.1. Camden s vision for substance misuse treatment is to:

SPECIFICATION FOR THE PROVISION OF A LOCAL COMMISSIONED SERVICE SERVICE: Opiate Drug Misuse Locally commissioned service PERIOD: 2 years with the option to extend for up to 3 years (1+1+1) Commence April

Assessment of Fitness to Drive to be completed by medical practitioner

COMMERCIAL VEHICLE DRIVER MEDICAL ASSESSMENT This Medical Assessment meets the requirements of the following Western Australian Government Authorities; Department of Commerce, WorkSafe - Occupational Safety

GMS Contract in Wales Enhanced Service for Homeless Patients Specification

Doc 4 GMS Contract in Wales 2008-09 Enhanced Service for Homeless Patients Specification Introduction The purpose of this paper is to provide an enhanced service specification for Local Health Boards when

DrinkCheck. Is your drinking okay?

DrinkCheck Is your drinking okay? WHAT SO OF DRIN ARE YOU DrinkCheck can help you about your drinking. Just questionnaire and add u Then find out what it me *DrinkCheck is for people 8 years or older.

CLIENT HISTORY CLIENT LEGAL NAME: CLIENT PREFERRED NAME:

CLIENT HISTORY CLIENT LEGAL NAME: DATE: CLIENT PREFERRED NAME: FAMILY & SOCIAL BACKGROUND Please list and describe your current family members (immediate, extended, adopted, etc.) and/or other members

MEDICAL HISTORY FORM FOR FOLLOW-UP

MEDICAL HISTORY FORM FOR FOLLOW-UP ID NUMBER: 0a) Date of Collection / / 0b) Staff Code Instructions: Whenever numerical responses are required, enter the number so that the last digit appears in the rightmost

APPLICATION FOR Page 1/8 RESIDENTIAL TREATMENT

APPLICATION FOR Page 1/8 Instructions: The following form is required to begin the application process to Stonehenge. The form should be printed and completed by hand, then faxed or mailed to Stonehenge

JOB DESCRIPTION. AF1 AF2 AF3 AG1 AG2 AG3 Assist in developing and delivering training packages on substance use and related AD2 AD3 AD4

JOB DESCRIPTION JOB TITLE: REPORTS TO: Band: BASE: OBJECTIVES OF POST: Substance Misuse worker Senior Substance Misuse Worker E ERP To provide referral, advice and brief interventions, some structured

Community Psychiatric Nurse. Consultant Psychiatrist, Substance Misuse Services

PATIENT GROUP DIRECTION (PGD) FOR THE ADMINISTRATION OF HEPATITIS A VACCINE (HAVRIX MONODOSE VACCINE) BY REGISTERED NURSES WORKING IN THE COMMUNITY SUBSTANCE MISUSE TEAMS Version Number : 2 Patient Group

IMPORTANT HEALTH INFORMATION

IMPORTANT HEALTH INFORMATION SU-6523MI Page 1 of 8 Table of Contents Page What is an HIV test?..........................................1 Will the HIV test tell me if I have AIDS?............................1

Conway PMS. NHS Health Check Questionnaire

Conway PMS NHS Health Check Questionnaire We would be grateful if you could kindly complete this survey. Please be as honest as possible to help us to help you. Name: Male Female D of B: dd / mm / yyyy

Referral Form. Emmaus

Referral Form All information provided will be treated with respect and will be held in strictest confidence, subject to the Data Protection Act 1998 and the Emmaus Data Protection Policy (available on

Chronic Hepatitis C The Patient s Perspective

Chronic Hepatitis C The Patient s Perspective Authors: Josie Smith, Marion Lyons Page 1 of 12 October 2006 Status: Final Contents: Page: Executive Summary 3 Introduction 4 Methodology 4 Findings 5 Appendix

1. RE-COMMISSIONING OF DRUG AND ALCOHOL TREATMENT AND RECOVERY SERVICES

Cabinet Member Decision 7 August 2014 1. RE-COMMISSIONING OF DRUG AND ALCOHOL TREATMENT AND RECOVERY SERVICES Relevant Cabinet Member Relevant Officer Recommendation Mr M J Hart Director of Adult Services

Implementing the 2017 President s Challenge: Primary, Secondary & Tertiary Prevention of Addiction & Substance Misuse

Implementing the 2017 President s Challenge: Primary, Secondary & Tertiary Prevention of Addiction & Substance Misuse Jay Butler, MD, President of ASTHO, Chief Medical Officer, Alaska Department of Health

Responsibilities for diabetes care. What care to expect and how to prepare for a consultation?

Responsibilities for diabetes care. What care to expect and how to prepare for a consultation? People with diabetes should expect to get the best of care to keep them in good health. In order to do this,

Rheumatoid Arthritis Template Guide 2014

Rheumatoid Arthritis Template Guide 2014 1 CEG produces a wide range of templates & guides All of these are available on our website!! Clinical Domain Clinical Domain 1 6 Week Check (Baby) 36 Mental Health

Current Hepatitis B and C Screening Practices for Migrants and Barriers to Screening

Current Hepatitis B and C Screening Practices for Migrants and Barriers to Screening Amena Ahmad, Ralf Reintjes Hamburg University of Applied Sciences, Germany European Conference on Migrant and Ethnic

Last Name Required to create unique record number (URN) in CAREWare and encrypted unique client ID (UCI) that is sent to HRSA for the RSR

Required Fields in Minnesota CAREWare The following table summarizes the fields that are required in Minnesota CAREWare. It also tells you whether the field is cross-provider (viewable/editable by all

Home and Community Based Services (HCBS)

To Whom It May Concern: To be considered for membership, the following must be submitted: 1. A Fountain House Membership Application and supplementary substance abuse questionnaire (included at the end

Central Lancashire. Community Pharmacy Needle Exchange Service

Central Lancashire Community Pharmacy Needle Exchange Service Service Level Agreement Services Covered Supply of needle exchange equipment and paraphernalia, information and advice related to injecting

Drugs, Alcohol and Substance Misuse Policy

1. Introduction 2. Scope of Policy 3. Overview and Policy Detail 4. Education, Intervention and Referral 5. Disruptive or Dangerous Behaviour 6. College Accommodation 7. Consequences 8. Status of Policy

Welcome to. St. Louis County Adult. Drug Court. This Handbook is designed to:

Welcome to St. Louis County Adult Drug Court This Handbook is designed to: Answer questions Address concerns Provide information about Drug Court As a participant in the program, you will be required to

Psychosis with coexisting substance misuse

Psychosis with coexisting substance misuse Clinical case scenarios for primary, secondary and third sector services Implementing NICE guidance March 2011 OTC α blocker information sheet for GP s (2010)

Appendix C. Aneurin Bevan Health Board. Smoke Free Environment Policy

Appendix C Aneurin Bevan Health Board Smoke Free Environment Policy Content 1. Policy statement 2. Introduction 3. Smoking restrictions within the Health Board 4. Responsibilities 5. Staff working in patients

TELEPHONE SCREENING DEMOGRAPHIC INFO

TELEPHONE SCREENING Provider Name: Provider Signature: Date: How did you hear about the hotline? DEMOGRAPHIC INFO 1 = Spouse 2 = Friend 3 = Medical Provider 4 = Flyer 5 = Parent 6 = State Hotline 7 = Physician

INITIAL ASSESSMENT (TCU METHADONE OUTPATIENT FORMS)

INITIAL ASSESSMENT (TCU METHADONE OUTPATIENT FORMS) [FORM 200; CARD 01] A. SITE:... [6] B. CLIENT ID NUMBER:... [7-10] C. SOURCE OF REFERRAL:... [11] 1. None/self 5. Other drug treatment program 2. Family

Statistics on Drug Misuse: England, 2008

Statistics on Drug Misuse: England, 2008 Summary This annual statistical report presents information on drug misuse among both adults and children. It includes a focus on young adults. The topics covered

Addiction History. Patient Assessment. Objectives. Cost. Initial Screen. Patient Assessment 25/04/2017. Substances. Age Started

Addiction History Patient Assessment Methadone and Suboxone 2017 Dr. Morris Markentin, 2017 Substances Current substance use and amount Age Started Each substance Route of use each substance Inhalation

Welcome to the second module of the Screening, Brief Intervention, and Referral to Treatment Core Curriculum. In this module, we ll address screening

Welcome to the second module of the Screening, Brief Intervention, and Referral to Treatment Core Curriculum. In this module, we ll address screening patients for substance use in a clinical setting. 1

JSNA Substance Misuse

JSNA Substance Misuse Introduction 9.1. Substance misuse causes less damage to health in absolute population terms than tobacco or alcohol. However, its association with crime and antisocial behaviour

Screening for Substance Use in Clinical Settings

Screening for Substance Use in Clinical Settings Screening, Brief Intervention, and Referral to Treatment (SBIRT) Core Curriculum The University of Iowa Goals for Today Understand universal screening Identify

Audit support for continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (review of technology appraisal guidance 57)

Audit support for continuous subcutaneous insulin (review of technology appraisal guidance 57) Issue date: 2008 Audit support Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus

Buprenorphine treatment

South London and Maudsley NHS Foundation Trust Buprenorphine treatment Information for service users Page Buprenorphine treatment What is buprenorphine? Buprenorphine (trade name Subutex ) is an opioid

Drugs and Alcohol Abuse Policy

Drugs and Alcohol Abuse Policy Introduction From the beginning of 2013, there are increased requirements to provide mandatory proof of inhouse drugs and alcohol testing procedures prior to employees being

The science of the mind: investigating mental health Treating addiction

The science of the mind: investigating mental health Treating addiction : is a Consultant Addiction Psychiatrist. She works in a drug and alcohol clinic which treats clients from an area of London with

POLICY AND GUIDANCE FOR MANAGERS ON STAFF SUBSTANCE MISUSE

POLICY AND GUIDANCE FOR MANAGERS ON STAFF SUBSTANCE MISUSE HEALTH & SAFETY UNIT AUTUMN 2012 CONTENTS 1 INTRODUCTION... ERROR! BOOKMARK NOT DEFINED. 2 AIM... ERROR! BOOKMARK NOT DEFINED. 3 APPLICATION...

Continuing Care Programme At Tabor Group, we believe that ongoing support and care is a vital part of long-term recovery from addiction. For many people, the 28-day treatment programme is only the first

Models of good practice in drug treatment in Europe. Project group

Models of good practice in drug treatment in Europe ( moretreat 2006329 ) Project group Hamburg, London, Rome, Stockholm, Vienna, Warsaw, Zurich Project duration: 17 months from April 2006 August 2008

Questions for first-stage health assessment at reception into prison

Questions for first-stage health assessment at reception into prison A printable version of Table 1 in NICE s guideline on the mental health of adults in contact with the criminal justice system. Topic

appendix 1: matrix scoring guide

. ACCOMMODATION appendix : matrix scoring guide. Suitability of Property I have been sleeping rough I am in hospital but cannot be discharged until accommodation is found for me It would be unreasonable

Lambeth Vulnerable Adult Pathway Health Needs Audit 2015

Lambeth Vulnerable Adult Pathway Health Needs Audit 2015 Contents Acknowledgements 3 Executive summary 4 Introduction 6 Methods 8 Section 1: Demographic Information 9 Sample size 9 Age 9 Ethnicity 10 Gender

Yellow PracticeNewPatient Information Card

Yellow PracticeNewPatient Infmation Card Date / / Surname MR/MRS/MISS/MS First Name(s) Date of Birth / / Home Tel: Wk Tel: Mobile Tel: Email Address: Address Post Code Height Weight Occupation Are you

H5VL 04 (SFH AB2) Support Individuals Who are Substance Users

H5VL 04 (SFH AB2) Support Individuals Who are Substance Users Overview For this standard you need to support individuals who are substance users by enabling them to adopt safe practices, providing care

CHAPTER 2 NETWORK PROVIDER/SERVICE DELIVERY REQUIREMENTS

CHAPTER 2 NETWORK PROVIDER/SERVICE DELIVERY REQUIREMENTS 2.9 SPECIAL POPULATIONS ADHS/DBHS receives Federal grants and State appropriations to deliver behavioral health services to special populations

Physical Issues: Emotional Issues: Legal Issues:

Men s Facility 1119 Ferry Street Lafayette, IN 47901 Phone: (765) 807-0009 Fax: (765) 807-0030 Hope Apartments 920 N 11th St. Lafayette, IN 47904 Phone: (765) 742-3246 Fax: (765) 269-9110 APPLICATION FOR

Wasted AN INTRODUCTION TO SUBSTANCE ABUSE

Wasted AN INTRODUCTION TO SUBSTANCE ABUSE Dr. Brian L. Bethel Child and Family Therapist Independent Trainer and Consultant LPCC-S, LCDC III, RPT-S www.brianlbethel.com INTERPLAY COUNSELING & CONSULTING

HIV MANAGEMENT PROGRAMME APPLICATION FORM

Private Private Bag X82081, Bag X82081, Rustenburg, Rustenburg, 0300 0300 Tel: Tel: (014) 590 5901700 1900 Fax: Fax: 086 (014) 577 0274 591 4570 www.platinumhealth.co.za www.platinumhealth.co.za ZZGPlatinumHealthClinicalMotivation@angloamerican.com

NIDA-Modified ASSIST Prescreen V1.0 1

NIDA-Modified ASSIST Prescreen V1.0 1 F Name:... Sex ( ) F ( ) M Age... Interviewer... Date.../.../... Introduction (Please read to patient) Hi, I m, nice to meet you. If it s okay with you, I d like to

Objectives. Patient Assessment Methadone and Suboxone Addiction History. Patient Assessment. Initial Screen. Cost 14/04/2016

Objectives Patient Assessment Methadone and Suboxone 2016 Proper assessment of a Patient with Opioid Addiction Clinical assessment Informed consent regarding OST, side effects and program restrictions

Index. Handbook SCREENING & TREATMENT ENHANCEMENT P A R T STEP. Guidelines and Program Information for First Felony and Misdemeanor Participants

SCREENING & TREATMENT ENHANCEMENT P A R T Index Welcome to STEP 3 What is STEP? 4 What s in it for me? 5 STEP Rules 6-8 STEP Phase Description and 9-16 Sanction Scheme Graduation 17 STEP webready STEP