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INITIAL CONTACT AND SCREENING

Initial Contact Data

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SCREENING FOR ADMISSION

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If None continue to 'Prior Substance Abuse Treatment?' Section

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If 'No' continue to 'Any History of Mental Health Issues' Section

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== == = Eligibility of Services = == ==

== == = Financial Eligibility= == ==

Person Responsible for payment:

Insurance Information:

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Onboarding Status:

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