The South Carolina ASAP/Education/Treatment Referral Form — Non CMS is a form used by the South Carolina Department of Alcohol and Other Drug Abuse Services (ADAS) to refer individuals for assessment, education, and/or treatment services. This form is to be used for individuals who are not enrolled in the Medicaid program and are seeking services from a non-Medicaid provider. The form includes the individual's demographic information, contact information, and referral information. It also includes questions about the individual's substance use history, their physical and mental health, and any barriers to treatment. The form has two types: an Adult Form and a Juvenile Form. The Adult Form is intended for individuals 18 years of age and older and the Juvenile Form is for individuals under 18 years of age. The form can be completed by a referring agency and submitted to the ADAS for processing.