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ILLINOIS DEPARTMENT OF HUMAN SERVICES Division of Substance Use Prevention and RecoveryAUTOMATED REPORTING AND TRACKING SYSTEM CLIENT/PATIENT ADMISSION DARTS DATA ENTRY FORMPROVIDER:UNIQUE CLIENT/PATIENT
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How to fill out substance abuse services application

01
Obtain the substance abuse services application form from the respective organization or agency providing the services.
02
Fill in your personal information accurately, such as your name, address, and contact details.
03
Provide relevant information about your substance abuse history, including the substances you have used and the duration of your use.
04
Answer any questions regarding your current or past treatment for substance abuse if applicable.
05
Provide information about your insurance coverage, if any, and any financial assistance you may require.
06
Include any additional information requested on the application form, such as medical history or co-occurring mental health conditions.
07
Ensure that you have signed and dated the application form.
08
Review the completed application form to ensure all information is accurate and complete.
09
Make copies of the application form and any supporting documents for your records.
10
Submit the completed application form to the designated agency or organization through the specified submission method (e.g., in-person, mail, online).

Who needs substance abuse services application?

01
Individuals who require substance abuse treatment or services.
02
Anyone struggling with drug or alcohol addiction.
03
Individuals who believe they would benefit from professional help in overcoming substance abuse issues.
04
People with a history of substance abuse seeking ongoing support and treatment.
05
Individuals who are mandated by the court or legal system to seek substance abuse services.
06
Families or loved ones of individuals struggling with substance abuse, who may be seeking assistance or resources.
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Substance abuse services application is a form used to apply for services related to substance abuse treatment and recovery.
Individuals seeking substance abuse treatment services and providers offering substance abuse services are required to file the application.
The application can be filled out online or in person by providing relevant personal and treatment information.
The purpose of the application is to request access to substance abuse treatment services and resources.
Information such as personal details, substance abuse history, treatment preferences, and insurance information must be reported on the application.
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