Do you have a drug & alcohol assessment from the past 30 days? Do you have a drug & alcohol assessment from the past 30 days? Yes No

Assessment resources Assessment resourcesAssessment resources

Have you completed detox? Have you completed detox? Yes No

Detox resources Detox resourcesDetox resources

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Do you have a drug & alcohol assessment from the past 30 days? Do you have a drug & alcohol assessment from the past 30 days? Yes No

Assessment resources Assessment resourcesAssessment resources

Is the patient scheduled/currently in a detox facility? Is the patient scheduled/currently in a detox facility? Yes No

Detox resources Detox resourcesDetox resources

Application form Application formApplication form