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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

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

Acute Treatment Services (ATS or Detox) Programs

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

Compulsive Gambling Programs

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

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

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

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

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

Family Residential - Adult

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

Family Residential and Family Supportive Housing - Children

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

Sober Living Programs

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

House of Correction Programs

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

MAT (OTP and OBOT)

MAT (OTP/OBOT) Disenrollment Assessment Form (DOCX) (English, DOCX 36.35 KB)
MAT (OTP/OBOT) Disenrollment Assessment Form (PDF) (English, PDF 272.95 KB)
MAT (OTP/OBOT) Enrollment Assessment Form (DOCX) (English, DOCX 45.21 KB)
MAT (OTP/OBOT) Enrollment Assessment Form (PDF) (English, PDF 364.06 KB)
Opioid Intake Form (English, RTF 427.24 KB)
Opioid Intake Manual (English, RTF 89.12 MB)
OTP Disenrollment Manual (English, RTF 714.2 KB)
OTP Enrollment Assessment Manual (English, RTF 1.11 MB)
OTP Periodic Assessment Form (DOCX) (English, DOCX 128.82 KB)
OTP Periodic Assessment Form (PDF) (English, PDF 212.91 KB)

Opioid Urgent Care Center

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

Outpatient Programs

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

Parole Re-entry Programs

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

CSS (Clinical Stabilization Services)

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

TSS (Transitional Support Services)

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

Residential Programs

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

Recovery Support Centers

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

Section 35 (Civil Commitment) Programs

Section 35 Disenrollment Assessment Form (English, RTF 2.95 MB)
Section 35 Disenrollment Manual (English, RTF 698.38 KB)
Section 35 Enrollment Assessment Form (English, RTF 3.16 MB)
Section 35 Enrollment Assessment Manual (English, RTF 1.34 MB)
Section 35 Intake Form (English, RTF 424.9 KB)
Section 35 Intake Manual (English, RTF 89.16 MB)

School Based Intervention

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

Moms Do Care (MDC)

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

Access to Recovery (ATR)

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

Collaborative and Transitional Models for MAT (CTM)

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

Home Visit Initiative (First Steps Together)

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

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