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  • Al Sasd Asais 4161 2007

Get Al Sasd Asais 4161 2007-2025

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.

  1. Click 'Get Form' button to access the AL SASD ASAIS 4161 form and open it in your browser.
  2. 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.
  3. Enter the ASAIS ID, first name, last name, and date of birth of the individual receiving services in the designated fields.
  4. Complete the co-dependent/collateral section if applicable, providing necessary details to identify their relationship to the individual.
  5. Specify the level of care at discharge by selecting the appropriate option from the listed categories.
  6. Document the date of the last contact and the date of discharge, filling out the sections accurately.
  7. Indicate whether the individual has a mental illness by marking 'Yes' or 'No' in the relevant field.
  8. Select the reason for discharge, transfer, or discontinuance of treatment from the provided options.
  9. Detail the problem substances, including types and frequency of use, by entering the primary, secondary, and tertiary substances as applicable.
  10. Address any co-occurring disorders and provide information regarding the treatment plan.
  11. Fill in the employment status, indicating the current employment situation of the individual.
  12. Complete the living arrangements section to describe the individual's current housing situation.
  13. 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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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232