This is a fictitious case. All names used in the doc are fictitious Sample Treatment Plan Recipient Information Provider Information
consent to examination and treatment for drug or chemical ... gan stands fully their plan of care, ... chemical addition, dependency or abuse. NO NO YES
Chemical-Dependency-Oient-Treatment-Plan_prov0513 PacificSource Health Plans and PacificSource Administrators Chemical Dependency Oient Treatment Plan
DSHS/DBHR Contract Agreement Template for Snce ... only within the context of a treatment plan. ... Medicaid chemical dependency treatment services for ...
Templates for many of these items can be found on the enclosed CD-Rom at the front of this notebook. ... An individ019s treatment and services plan must be
CHEMICAL DEPENDENCY/SNCE ABUSE INPATIENT REFERRAL FORM ... Monroe Plan Contract N: ... CD TREATMENT HISTORY:
For the pe of this plan, we refer to chemical dependency and mental illness, ... in need of chemical dependency treatment received needed services. 25
that will allow his/her chemical dependency coor or treatment program to ... Employees Last Name will be placed on a Performance Plan for the first six ...
k. Treatment plan: modality, freq, self-help attendance, ... All patients referred for evaln and/or treatment of chemical dependency must
HEIT TEMPLATE.PPT 1 Emerging Practices in Pain and Chemical Dependency: 2010 e on Opioid Therapy ... Confirmation of the agreed upon treatment plan
Prepare a treatment plan that integrates client goals and reso. GEO 1,2,4,5,6,7,8 ... Wor-Wic Comm College Chemical Dependency Coing Program
Plan prepared by: Ted L. Ely, Mental Health Coordinator CPC ... licensed hospital or chemical dependency treatment provider which will accept the individual with
Chemical Dependency coding changes ... defined in the members treatment plan. ed Jan. 31, 2013 ... Template A: