Adult (Parent) Record Documentation
Child Record Documentation
Adult (Parent) Record
- Instructions for Interview Documents (PDF)
- Authorization/Denial to Obtain or Release Information and Records (PDF)
- Case Management Contact (PDF)
- Confidentiality of Substance Abuse Client Records (PDF)
- Consent for Release of Confidential Alcohol or Drug Treatment Information (PDF)
- Face Sheet (PDF)
- Resident Intake Form (PDF)
- Instructions for Admission Documents (PDF)
- Acknowledgement of Items Received (PDF)
- Aftercare Agreement (PDF)
- Babysitter Agreement (PDF)
- Code of Conduct (PDF)
- Consent for the Release of Communicable Disease Info (PDF)
- Consent for the Release of Confidential Alcohol or Drug Treatment and HIV/AIDS Information to Comply with Disease Reporting Requirements (PDF)
- Consent to Photograph for Resident Record (PDF)
- Drug and Alcohol Testing Consent (PDF)
- Emergency Child Placement Agreement (PDF)
- Emergency Medical Treatment Authorization Form (PDF)
- Exit Policy (PDF)
- Family Responsibilities (PDF)
- Family Rights (PDF)
- Food Stamp Contribution Agreement (PDF)
- Initial Service Plan Budget Agreement (PDF)
- Medication Consent (PDF)
- Receipt of Orientation Documents (PDF)
- Resident Agreement Consent to Services (PDF)
- Resident Agreement to Accept Differences (PDF)
- SPHERE HIV Risk Assessment (PDF)
- SPHERE HIV Risk Assessment User's Manual (PDF)
Service Provision Documentation
- Instructions for Service Provision Documents (PDF)
- Area of Concern (PDF)
- Babysitting Consent Agreement (PDF)
- Case Conference Review (PDF)
- Case Management Note Supplement (PDF)
- Case Notes (PDF)
- Child Information Sheet (PDF)
- Children's Outside Visit Authorization (PDF)
- Chore Warning (PDF)
- Documentation of a Physical Examination (PDF)
- Family Service Plan Sample One (PDF)
- Family Service Plan Sample Two (PDF)
- Group Note (PDF)
- Health Education Sign-offs (PDF)
- Hepatitis Public Health Fact Sheets
- Medical Encounter Form (PDF)
- Non-Compliance Warning (PDF)
- Resident Phase Review Form (PDF)
- Time Planning (PDF)
- Weekly Case Management Summary (PDF)
- Instructions for Discharge Documents (PDF)
- Aftercare Plan (PDF)
- Discharge Summary (PDF)
- Receipt of Property Form (PDF)
- Release of Medication (PDF)
- Resident Satisfaction Survey - Sample One (PDF)
- Resident Satisfaction Survey - Sample Two (PDF)
Child Record
- Instructions for Admission Documents (PDF)
- Authorization/Denial to Obtain Release Information (PDF)
- Child Admission Form (PDF)
- Consent for Release of Confidential Alcohol or Drug Treatment Information (PDF)
- Family Shelter Child Record Check Sheet (PDF)
- Guidelines Regarding Sick Children (PDF)
- Kid's Rules (PDF)
- Teenage Policy (PDF)
Service Provision Documentation
- Instructions for Service Provision Documents (PDF)
- Children's Referral for Outside Services (PDF)
- Medical Encounter Form (PDF)
- Weekly Child Case Review (PDF)
This information is provided by the Bureau of Substance Abuse Services within the Department of Public Health.