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SUBSTANCE ABUSE SERVICES REQUEST FOR TECHNICAL ASSISTANCE (Please type or print) SECTION I. Please complete and submit this form to: ODESSA Attn: Amish Harrison P.O. Box 53277 Oklahoma City, OK 73152

How to fill out substance abuse services request

How to fill out substance abuse services request:

1. Obtain the form: Start by obtaining the substance abuse services request form. This form may be available online or through the specific organization or agency providing the services.
2. Provide personal information: Begin filling out the form by providing your personal information. This may include your full name, date of birth, address, contact information, and any other required details.
3. Specify the substance abuse issue: Indicate the specific substance abuse issue that you or the person you are requesting services for is struggling with. This could include alcohol, drugs, prescription medication, or any other form of substance abuse.
4. Describe the severity and duration: Describe the severity and duration of the substance abuse problem. Provide an accurate assessment of the current situation to help the service provider understand the level of assistance needed.
5. Medical history and current health status: Include any relevant medical history or current health status that may impact the substance abuse treatment or services required. This can provide additional context and help service providers customize their support.
6. Outline previous treatment attempts: Briefly outline any previous attempts at substance abuse treatment, including any programs or therapies that have been tried before. This information can help service providers understand what has worked or not worked in the past.
7. Additional support needed: Specify any additional support or services that may be required, such as counseling, therapy, detoxification, support groups, or other related programs. Be as specific as possible to ensure appropriate assistance is provided.
8. Provide emergency contact information: Include emergency contact information, such as a trusted person's name, contact number, and relationship to you. This is crucial in case of any emergency or immediate intervention required.
9. Sign and date the request: Sign and date the completed substance abuse services request form. Make sure to review all the information provided to ensure accuracy before submitting it to the appropriate agency or organization.

Who needs substance abuse services request?

1. Individuals struggling with substance abuse: Individuals who are facing substance abuse issues, whether it is alcohol, drugs, or other substances, may need to fill out a substance abuse services request. This request helps them seek the necessary support and treatment to address their addiction.
2. Family members or friends: Family members or friends who are concerned about a loved one's substance abuse problem may also need to fill out a substance abuse services request. By doing so, they can demonstrate their support and commitment to helping their loved one seek the required assistance.
3. Healthcare professionals: Healthcare professionals, including doctors, nurses, counselors, or therapists, who come across individuals with substance abuse issues may also need to fill out a substance abuse services request. This enables them to refer their patients or clients to the appropriate services for comprehensive treatment and support.

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What is substance abuse services request?

Substance abuse services request is a formal application or document submitted to request services related to the treatment or prevention of substance abuse.

Who is required to file substance abuse services request?

Any individual, organization, or institution that requires substance abuse services can file a substance abuse services request.

How to fill out substance abuse services request?

To fill out a substance abuse services request, you need to include necessary personal or organizational information, provide details about the requested services, and complete any required sections or forms as instructed.

What is the purpose of substance abuse services request?

The purpose of a substance abuse services request is to formally request and access services related to the treatment, prevention, or support for substance abuse issues.

What information must be reported on substance abuse services request?

The required information on a substance abuse services request may vary, but commonly includes personal or organizational details, specific service needs or objectives, relevant medical or clinical information, and any supporting documentation.

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