ࡱ>  Root Entry F" @Data v1TableAWordDocumentJ  <N6R 7;=:?@ABCDEFGHIK Discharge/Transfer Criteria Date of Discharge/Transfer __________ Patient Name _____________________________________ CDP summary report of patient progress towards meeting short and long range treatment goals for each Dimension listed on the individual treatment plan, based on the Chemical Dependency assessment: DIMENSION _____ Present ASAM Level of Care _________ As evidenced by:_____________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________  FORMCHECKBOX  The patient has achieved the treatment goals in the individual treatment plan and has resolved the problem that justified admission to the present level of care.  FORMCHECKBOX  The patient has been unable to resolve the problem that justified admission to the present level of care, despite amendments to the treatment plan.  FORMCHECKBOX  The patient has demonstrated a lack of capacity to resolve the problem at the present level of care.  FORMCHECKBOX  The patient has experienced an intensification of the problem that cannot be met at the present level of care.  FORMCHECKBOX  The patient has developed a new problem in this Dimension that cannot be treated effectively at the present level of care. DIMENSION _____ Present ASAM Level of Care _________ As evidenced by:_____________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________  FORMCHECKBOX  The patient has achieved the treatment goals in the individual treatment plan and has resolved the problem that justified admission to the present level of care.  FORMCHECKBOX  The patient has been unable to resolve the problem that justified admission to the present level of care, despite amendments to the treatment plan.  FORMCHECKBOX  The patient has demonstrated a lack of capacity to resolve the problem at the present level of care.  FORMCHECKBOX  The patient has experienced an intensification of the problem that cannot be met at the present level of care.  FORMCHECKBOX  The patient has developed a new problem in this Dimension that cannot be treated effectively at the present level of care.   FORMCHECKBOX  The patient presently meets the criteria for treatment in Level _______. Treatment will continue at: __________________________________ Start Date _______________  FORMCHECKBOX  The patient has elected not to continue in the recommended treatment.  FORMCHECKBOX  The recommended treatment is not available to the patient because___________________. 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( t { 333333Julian Gonzales_C:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of DISCHARGE SUMMARY - CC PLAN.asdJulian Gonzales_C:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of DISCHARGE SUMMARY - CC PLAN.asdJulian Gonzales_C:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of DISCHARGE SUMMARY - CC PLAN.asdJulian Gonzales_C:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of DISCHARGE SUMMARY - CC PLAN.asdJulian Gonzales_C:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of DISCHARGE SUMMARY - CC PLAN.asdJulian Gonzales_C:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of DISCHARGE SUMMARY - CC PLAN.asdJulian Gonzales_C:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of DISCHARGE SUMMARY - CC PLAN.asdJulian Gonzales_C:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of DISCHARGE SUMMARY - CC PLAN.asdJulian Gonzales_C:\WINDOWS\Application Data\Microsoft\Word\AutoRecovery save of DISCHARGE SUMMARY - CC PLAN.asdJulian Gonzales`C:\My Documents\Certification Documents\TA resources\DRAFT forms\DISCHARGE SUMMARY - CC PLAN.doc@ 0(  @UnknownG:Times New Roman5Symbol3& :Arial"hdFdF4 Yp20 2Q&Discharge Summary/ Continued Care PlanJulian GonzalesJulian Gonzales Oh+'0 0< X d p|'Discharge Summary/ Continued Care Plan iscJulian Gonzalesuliuli Normal.dotaJulian Gonzales2liMicrosoft Word 9.0C@8C@r@:  ՜.+,0 hp   dshs-dasa   'Discharge Summary/ Continued Care Plan Title  "#$%&'(*+,-./03Root Entry F`7O5Data 1TableAWordDocument"SummaryInformation(!DocumentSummaryInformation8)CompObjjObjectPool`7O`7O  FMicrosoft Word Document MSWordDocWord.Document.89qvDeCheck12Data 1TableWordDocument* Oh+'0 0< X d p|'Discharge Summary/ Continued Care Plan iscJulian Gonzalesuliuli Normal.dotaJulian Gonzales3liMicrosoft Word 9.0C@Ɣ @r@   ՜.+,0 hp   dshs-dasa f  'Discharge Summary/ Continued Care Plan Title 1/ =!"#$%Chemical Dependency Professional (CDP)ITreatment Psed on the Chemical Dependency APPC treated effectively PPCtreated effectively ASAM PPC admission with  FORMCHECKBOX  No further treatment is needed or recommended at this time.  [ \ ] k l m k l m n o } ~  &'567~VXtvxܸzj5CJU\CJCJ5\j5CJU\j5CJU\j$5CJU\j5CJU\j5CJU\j5CJU\ 5CJ\ 5CJ\j5CJU\j,5CJU\0[ \ k l n &~67V 0<^`0xdh 0^`0 i<@< NormalCJOJQJ_HmH sH tH 6@6 Heading 1$@& 5CJ\8`8 Heading 2$$@&a$5\<`< Heading 3$$@&a$ 5CJ\<A@< Default Paragraph Font\$@\ Envelope Address!@ &+D/^@ ^JaJ*>@* Title$a$5\,@, Header  !, @", Footer  !6B@26 Body Textdh 5CJ\I w_`Khs!  y ; , - ? F J 00000000000000000000000000000000(0@0 0   [   K[hx s)! 1 y ; K I G$G$G$G$G$G$G$G$G$G$G$G G G Check5Check6Check7Check8Check9Check4Check10Check11Check12Li z < J \y  L J   ? G J AKZ b   ? 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G H I @"@n @pr @b @ @F@J@@@L@@@@@v@z@@@~@@@&8@@@L@TVXZrtvx@@J@8@J@UnknownG:Times New Roman5Symbol3& :Arial"hdF!dFA Yp24f 2Q&Discharge Summary/ Continued Care PlanJulian GonzalesJulian GonzalesT]M bjbj==WW? ltttttt8u8L($+ Kt,tt/,,,"tt,,,tt .^E0u,,ttttRoot Entry F.QData v1TableAWordDocumentJ <6 7;=:?@ABCDEFGHIKONR0Table>SummaryInformation(DocumentSummaryInformation8HCompObjjObjectPool`7O`7O   FMicrosoft Word Document MSWordDocWord.Document.89q ՜.+,0 hp   dshs-dasa f  'Discharge Summary/ Continued Care Plan Title Oh+'0 0< X d p|'Discharge Summary/ Continued Care Plan iscJulian Gonzalesuliuli Normal.dotaJulian Gonzales3liMicrosoft Word 9.0C@Ɣ @r@