Get Wi Upc

The Wisconsin Uniform Placement Criteria (WI UPC) is a crucial document for assessing placement needs related to substance abuse treatment. This guide provides clear, step-by-step instructions on how to fill out the form online, making the process accessible for all users.

Follow the steps to complete the WI UPC form effectively.

1. Press the ‘Get Form’ button to obtain the WI UPC form and open it in the editor.
2. Fill in the date of completion in the designated field.
3. Enter the patient’s name in the appropriate section.
4. Provide the patient’s phone number, including area code.
5. Input the patient’s date of birth in the specified format.
6. Record the patient’s home address, including city, state, and zip code.
7. Enter the interviewer's name and phone number.
8. Input the agency name and corresponding phone number.
9. Provide the agency address, including city, state, and zip code.
10. Identify and rule out intoxication and/or incapacitation by completing Step I.
11. Complete the substance abuse screening as instructed in Step II.
12. Evaluate the patient for treatment service qualifying criteria (Step III).
13. Assess patient within treatment dimensions and severity indicators (Step IV).
14. Transfer treatment indicator scores to the grid and identify the recommended level of care (Step V).
15. Fill in the Interviewer’s Comments section and note any need for an alternative level of care (Step VI).
16. Record the patient’s Willingness/Acceptance statement (Step VII).
17. Complete the referral information and signature section as required (Step VIII).
18. Once all sections are filled, save your changes, then download, print, or share the completed form.

Start filling out the WI UPC form online today!