
ASAIS ID: First Name: Last Name: Date of Birth: / / Co-Dependent/Collateral: Level of Care at Discharge: / Date of Last Contact: / Date of Discharge: MI: Yes No / / Reason for Discharge, Transfer or Discontinuance of Treatment Treatment Completed Left Against Professional Advice Terminated by Facility Transferred to Another Substance Abuse Treatment Program or Facility Transferred to Another Substance Abuse Treatment Program or Facility, but Did Not Report Incar.
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How to fill out the AL SASD ASAIS 4161 online
The AL SASD ASAIS 4161 form is a crucial document for reporting the discharge summary of individuals receiving substance abuse treatment. This guide will provide a professional and supportive walkthrough on how to fill out the form online, ensuring clarity and ease of use for all individuals.
Follow the steps to successfully complete the AL SASD ASAIS 4161 form online.
- Click 'Get Form' button to access the AL SASD ASAIS 4161 form and open it in your browser.
- Fill in the date of entry in the appropriate format (MM/DD/YYYY). Provide the provider ID and the name of the person submitting the form.
- Enter the ASAIS ID, first name, last name, and date of birth of the individual receiving services in the designated fields.
- Complete the co-dependent/collateral section if applicable, providing necessary details to identify their relationship to the individual.
- Specify the level of care at discharge by selecting the appropriate option from the listed categories.
- Document the date of the last contact and the date of discharge, filling out the sections accurately.
- Indicate whether the individual has a mental illness by marking 'Yes' or 'No' in the relevant field.
- Select the reason for discharge, transfer, or discontinuance of treatment from the provided options.
- Detail the problem substances, including types and frequency of use, by entering the primary, secondary, and tertiary substances as applicable.
- Address any co-occurring disorders and provide information regarding the treatment plan.
- Fill in the employment status, indicating the current employment situation of the individual.
- Complete the living arrangements section to describe the individual's current housing situation.
- Finally, save your changes and choose whether to download, print, or share the completed form.
Complete your documents online today for a streamlined process.
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