Substance Abuse Biopsychosocial Assessment Template

Substance use screening and assessment database this resource created by the alcohol and drug abuse institute library at the university of washington is intended to help clinicians and researchers find instruments used for screening and assessment of substance use and substance use disorders.

Substance abuse biopsychosocial assessment template. No previous treatment name of treatment program type of treatment date of treatment status. Instruments whose validity and reliability have been well studied are marked with a star. Her chief complaint is i am so anxious all the time that i cannot. Drug alcohol assessment which substances are currently used method of use oral inhalation intranasal.

Superscripts indicate the category of substance with which each symptom is associated in the dsm 5. Behavioral health substance abuse network inc. Template for assessing a client s substance use developed by cynthia glidden tracey ph d. Substance abuse history include any information on substances abused present past age of fist use date of last use method of use relapses and if they are in recovery.

Please include information on caffeine and nicotine use here. Medical history and current status. Current symptom checklist rate intensity of symptoms currently present. Pattern of use.

We are required under state law to report suspected abuse of a child elderly person or individual with a disability or any reported sexual misconduct by a licensed health care provider. Chemical dependency specific bio psychosocial assessment history. 301 613 2750 patient name patient id patient ss date 1 biopsychosocial history intake form presenting problems presenting problems duration months additional information. Cynthia glidden tracey assessment template continuingedcourses net page 2 category of drug first use.

We may share limited information in the event of a medical emergency or in the event of a specialized. Jones is a 37 year old woman. Abuse assessment in the past year has the patient been hit kicked or physically hurt by another person. If you are a new clinician or still in school you might be wondering how to write up a thorough biopsychosocial assessment for a client.

Involvement in a crime against property or personnel. Bhsan 600 w street ne washington dc 20002 tel. The only words. This post offers an example of a clinical assessment and mental health treatment plan examples for that assessment.

This sample inpatient substance abuse chart was created in the icanotes behavioral health ehr. The client stated that he suffers from high blood pressure and he was recently diagnosed with type ii diabetes. He is currently taking medication to lower and stabilize his blood sugar levels. History of treatments did they complete or not.

Clinton counseling center adult biopsychosocial assessment demographics legal name. When you are writing one of these it is important to follow the mental health assessment format. And for what length o f time. The client reported that he had no previous treatment for alcohol or drugs.