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ESM assessment forms and manuals

Please find the following on this page: The ESM training schedule, Intake forms and manuals, Enrollment and Disenrollment Assessment forms and manuals

ESM training

This training will assist the provider with the submission of quality data. The training helps providers better understand how to enter the information requested by BSAS.

The training includes testing and a Certificate of Completion. It is highly recommended for all staff who works with the ESM Intake, Enrollment, and Disenrollment Forms.

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EIM/ESM Release of Client/Confidential Information

Open DOCX file, 21.62 KB,  EIM/ESM Release of Client/Confidential Information - English (English, DOCX 21.62 KB)
Open PDF file, 24.78 KB,  EIM/ESM Release of Client/Confidential Information - English (English, PDF 24.78 KB)
Open DOCX file, 21.21 KB,  EIM/ESM Release of Client/Confidential Information - Spanish (Spanish, DOCX 21.21 KB)
Open PDF file, 25.11 KB,  EIM/ESM Release of Client/Confidential Information - Spanish (Spanish, PDF 25.11 KB)

Acute Treatment Services (ATS or Detox) Programs

Open RTF file, 2.92 MB,  ATS Disenrollment Assessment Form (DOCX) (English, RTF 2.92 MB)
Open PDF file, 276.87 KB,  ATS Disenrollment Assessment Form (PDF) (English, PDF 276.87 KB)
Open RTF file, 640.54 KB,  ATS Disenrollment Manual (English, RTF 640.54 KB)
Open RTF file, 3.1 MB,  ATS Enrollment Assessment Form (DOCX) (English, RTF 3.1 MB)
Open PDF file, 316.44 KB,  ATS Enrollment Assessment Form (PDF) (English, PDF 316.44 KB)
Open RTF file, 846.84 KB,  ATS Enrollment Manual (English, RTF 846.84 KB)
Open RTF file, 422.17 KB,  ATS Intake Form (English, RTF 422.17 KB)
Open RTF file, 89.17 MB,  ATS Intake Manual (English, RTF 89.17 MB)

Compulsive Gambling Programs

Open RTF file, 2.75 MB,  Gambling Disenrollment Assessment Form (English, RTF 2.75 MB)
Open RTF file, 416.9 KB,  Gambling Disenrollment Assessment Manual (English, RTF 416.9 KB)
Open RTF file, 2.84 MB,  Gambling Enrollment Assessment Form (English, RTF 2.84 MB)
Open RTF file, 511.91 KB,  Gambling Enrollment Assessment Manual (English, RTF 511.91 KB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

MA Impaired Driver (MID) - First Offender (formerly known as DAE-First Offender)

Open RTF file, 980.27 KB,  DAE Disenrollment Manual (English, RTF 980.27 KB)
Open RTF file, 896.82 KB,  DAE Enrollment Manual (English, RTF 896.82 KB)
Open RTF file, 2.96 MB,  MID-DAE First Offender Disenrollment Assessment (English, RTF 2.96 MB)
Open RTF file, 3.08 MB,  MID-DAE First Offender Enrollment Assessment Form (English, RTF 3.08 MB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

MA Impaired Driver (MID) - Second Offender (Aftercare and 14-Day Residential)

Open RTF file, 2.95 MB,  Standard Disenrollment Form (English, RTF 2.95 MB)
Open RTF file, 3.11 MB,  Standard Enrollment Assessment Form (English, RTF 3.11 MB)
Open RTF file, 426.47 KB,  Standard Intake (English, RTF 426.47 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

Family Residential - Adult

Open RTF file, 428.19 KB,  Family Residential & Sober Living Intake Form - Adult (English, RTF 428.19 KB)
Open RTF file, 89.17 MB,  Family Residential & Sober Living Intake Manual - Adult (English, RTF 89.17 MB)
Open RTF file, 3.23 MB,  Residential Disenrollment Assessment Form (English, RTF 3.23 MB)
Open RTF file, 756.02 KB,  Residential Disenrollment Manual (English, RTF 756.02 KB)
Open RTF file, 3.28 MB,  Residential Enrollment Assessment Form (English, RTF 3.28 MB)

Family Residential and Family Supportive Housing - Children

Open RTF file, 2.6 MB,  Family Residential & Sober Living Disenrollment Assessment Form - Children (English, RTF 2.6 MB)
Open RTF file, 463.92 KB,  Family Residential & Sober Living Disenrollment Assessment Manual - Children (English, RTF 463.92 KB)
Open RTF file, 2.63 MB,  Family Residential & Sober Living Enrollment Assessment Form - Children (English, RTF 2.63 MB)
Open RTF file, 523.91 KB,  Family Residential & Sober Living Enrollment Assessment Manual - Children (English, RTF 523.91 KB)
Open RTF file, 425.57 KB,  Family Residential & Sober Living Intake Form - Children (English, RTF 425.57 KB)
Open RTF file, 1.38 MB,  Family Residential & Sober Living Intake Manual - Children (English, RTF 1.38 MB)

Sober Living Programs

Open RTF file, 2.95 MB,  Standard Disenrollment Form (English, RTF 2.95 MB)
Open RTF file, 3.11 MB,  Standard Enrollment Assessment Form (English, RTF 3.11 MB)
Open RTF file, 873.6 KB,  Standard Enrollment Assessment Manual (English, RTF 873.6 KB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

House of Correction Programs

Open RTF file, 2.94 MB,  House of Correction Disenrollment Assessment Form (English, RTF 2.94 MB)
Open RTF file, 635.47 KB,  House of Correction Disenrollment Assessment Manual (English, RTF 635.47 KB)
Open RTF file, 3.09 MB,  House of Correction Enrollment Assessment Form (English, RTF 3.09 MB)
Open RTF file, 791.2 KB,  House of Correction Enrollment Assessment Manual (English, RTF 791.2 KB)
Open RTF file, 374.45 KB,  House of Correction Intake Form (English, RTF 374.45 KB)
Open RTF file, 1.25 MB,  House of Correction Intake Manual (English, RTF 1.25 MB)

MAT (OTP and OBOT)

Open DOCX file, 36.35 KB,  MAT (OTP/OBOT) Disenrollment Assessment Form (DOCX) (English, DOCX 36.35 KB)
Open PDF file, 272.95 KB,  MAT (OTP/OBOT) Disenrollment Assessment Form (PDF) (English, PDF 272.95 KB)
Open DOCX file, 45.21 KB,  MAT (OTP/OBOT) Enrollment Assessment Form (DOCX) (English, DOCX 45.21 KB)
Open PDF file, 364.06 KB,  MAT (OTP/OBOT) Enrollment Assessment Form (PDF) (English, PDF 364.06 KB)
Open RTF file, 427.24 KB,  Opioid Intake Form (English, RTF 427.24 KB)
Open RTF file, 89.12 MB,  Opioid Intake Manual (English, RTF 89.12 MB)
Open RTF file, 714.2 KB,  OTP Disenrollment Manual (English, RTF 714.2 KB)
Open RTF file, 1.11 MB,  OTP Enrollment Assessment Manual (English, RTF 1.11 MB)
Open DOCX file, 26.7 KB,  OTP Periodic Assessment Form (DOCX) (English, DOCX 26.7 KB)
Open PDF file, 197.61 KB,  OTP Periodic Assessment Form (PDF) (English, PDF 197.61 KB)

Opioid Urgent Care Center

Open DOCX file, 37.51 KB,  OUCC Abbreviated Disenrollment Form (English, DOCX 37.51 KB)
Open DOCX file, 357.11 KB,  OUCC Enrollment/Disenrollment Manual (English, DOCX 357.11 KB)
Open RTF file, 3.11 MB,  Standard Enrollment Assessment Form (English, RTF 3.11 MB)
Open RTF file, 873.6 KB,  Standard Enrollment Assessment Manual (English, RTF 873.6 KB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

Outpatient Programs

Open RTF file, 2.95 MB,  Standard Disenrollment Assessment Form (English, RTF 2.95 MB)
Open RTF file, 659.21 KB,  Standard Disenrollment Manual (English, RTF 659.21 KB)
Open RTF file, 3.11 MB,  Standard Enrollment Assessment Form (English, RTF 3.11 MB)
Open RTF file, 873.6 KB,  Standard Enrollment Assessment Manual (English, RTF 873.6 KB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

Parole Re-entry Programs

Open RTF file, 2.94 MB,  Parole Disenrollment Assessment Form (English, RTF 2.94 MB)
Open RTF file, 676.05 KB,  Parole Disenrollment Manual (English, RTF 676.05 KB)
Open RTF file, 3.11 MB,  Parole Enrollment Assessment Form (English, RTF 3.11 MB)
Open RTF file, 836.61 KB,  Parole Enrollment Manual (English, RTF 836.61 KB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

CSS (Clinical Stabilization Services)

Open RTF file, 2.97 MB,  CSS Disenrollment Assessment Forms (English, RTF 2.97 MB)
Open RTF file, 3.12 MB,  CSS Enrollment Assessment Forms (English, RTF 3.12 MB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)

TSS (Transitional Support Services)

Open RTF file, 2.95 MB,  Standard Disenrollment Assessment Form (English, RTF 2.95 MB)
Open RTF file, 659.21 KB,  Standard Disenrollment Manual (English, RTF 659.21 KB)
Open RTF file, 3.11 MB,  Standard Enrollment Assessment Form (English, RTF 3.11 MB)
Open RTF file, 873.6 KB,  Standard Enrollment Assessment Manual (English, RTF 873.6 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

Residential Programs

Open RTF file, 3.23 MB,  Residential Disenrollment Assessment Form (English, RTF 3.23 MB)
Open RTF file, 756.02 KB,  Residential Disenrollment Manual (English, RTF 756.02 KB)
Open RTF file, 3.28 MB,  Residential Enrollment Assessment Form (English, RTF 3.28 MB)
Open RTF file, 920.75 KB,  Residential Enrollment Manual (English, RTF 920.75 KB)
Open RTF file, 435.6 KB,  Residential Intake Form (English, RTF 435.6 KB)
Open RTF file, 89.14 MB,  Residential Intake Manual (English, RTF 89.14 MB)

Recovery Support Centers

Open RTF file, 121.83 KB,  Recovery Support Center Intake Form (English, RTF 121.83 KB)
Open RTF file, 370.06 KB,  Recovery Support Center Survey (English, RTF 370.06 KB)

Section 35 (Civil Commitment) Programs

Open DOCX file, 116.88 KB,  Section 35 Disenrollment Assessment Form (English, DOCX 116.88 KB)
Open PDF file, 429.76 KB,  Section 35 Disenrollment Assessment Form (English, PDF 429.76 KB)
Open RTF file, 698.38 KB,  Section 35 Disenrollment Manual (English, RTF 698.38 KB)
Open RTF file, 3.16 MB,  Section 35 Enrollment Assessment Form (English, RTF 3.16 MB)
Open RTF file, 1.34 MB,  Section 35 Enrollment Assessment Manual (English, RTF 1.34 MB)
Open RTF file, 424.9 KB,  Section 35 Intake Form (English, RTF 424.9 KB)
Open RTF file, 89.16 MB,  Section 35 Intake Manual (English, RTF 89.16 MB)

School Based Intervention

Open RTF file, 2.43 MB,  School Based Intervention Disenrollment Form (English, RTF 2.43 MB)
Open RTF file, 319.33 KB,  School Based Intervention Intake Form (English, RTF 319.33 KB)

Moms Do Care (MDC)

Open RTF file, 2.95 MB,  Moms Do Care Disenrollment Form (English, RTF 2.95 MB)
Open RTF file, 3.02 MB,  Moms Do Care Enrollment Form (English, RTF 3.02 MB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

Access to Recovery (ATR)

Open RTF file, 2.92 MB,  ATR Disenrollment Form (English, RTF 2.92 MB)
Open RTF file, 2.96 MB,  ATR Enrollment Form (English, RTF 2.96 MB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

Collaborative and Transitional Models for MAT (CTM)

Open RTF file, 2.95 MB,  Standard Disenrollment Assessment Form (English, RTF 2.95 MB)
Open RTF file, 3.11 MB,  Standard Enrollment Assessment Form (English, RTF 3.11 MB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

Home Visit Initiative (First Steps Together)

Open RTF file, 2.95 MB,  HVI Disenrollment Assessment Form (English, RTF 2.95 MB)
Open RTF file, 3.02 MB,  HVI Enrollment Assessment Form (English, RTF 3.02 MB)
Open RTF file, 423.5 KB,  Standard Intake Form (English, RTF 423.5 KB)
Open RTF file, 89.15 MB,  Standard Intake Manual (English, RTF 89.15 MB)

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