Get the free Substance Use Disorder Referral Form - Nystrom & Associates

Substance Use Disorder Referral Form Date:Referents Name/Facility: Referents Phone number: Referents Fax Number:Clients Name: Male/Female DOB: Phone #: Drug Court Involvement: Yes or No Address: City:

How to fill out substance use disorder referral

How to fill out substance use disorder referral

1. To fill out a substance use disorder referral, follow these steps:
2. Begin by gathering all the necessary information about the individual requiring the referral, such as their full name, contact information, and date of birth.
3. Write a detailed description of the individual's substance use disorder, including the specific substances they abuse and the severity of their addiction.
4. Include any relevant medical or mental health history that may be important in the treatment process.
5. Specify the type of treatment or program that is being recommended for the individual. This can include outpatient counseling, inpatient rehabilitation, or medication-assisted treatment.
6. Provide any additional details or instructions that may be helpful for the receiving party to know, such as any known preferences or restrictions for the individual.
7. Make sure to sign and date the referral form before submitting it to the appropriate recipient.
8. Keep a copy of the referral for your records and provide a copy to the individual seeking treatment, if necessary.
9. Note: It's always recommended to consult with a healthcare professional or addiction specialist for guidance specific to the referral process in your jurisdiction.

Who needs substance use disorder referral?

1. Anyone who is dealing with a substance use disorder and requires professional treatment or support would benefit from a substance use disorder referral.
2. This can include individuals who are struggling with drug or alcohol addiction and need assistance in finding appropriate treatment resources.
3. The referral may be needed for people who are seeking outpatient counseling, inpatient rehabilitation programs, or medication-assisted treatment.
4. Both adolescents and adults who are battling substance abuse can benefit from a substance use disorder referral.
5. It's important for friends, family members, or loved ones of individuals with substance use disorder to seek a referral to help their loved one find the necessary treatment and support.
6. Remember, a substance use disorder referral is an important step towards accessing the appropriate resources and starting the journey towards recovery.

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What is substance use disorder referral?

Substance use disorder referral is a process where individuals with substance abuse issues are referred to appropriate treatment services.

Who is required to file substance use disorder referral?

Healthcare providers, social workers, or counselors are typically required to file substance use disorder referrals.

How to fill out substance use disorder referral?

To fill out a substance use disorder referral, health professionals must gather detailed information about the individual's substance abuse history and treatment needs.

What is the purpose of substance use disorder referral?

The purpose of substance use disorder referral is to connect individuals struggling with substance abuse to treatment and support services.

What information must be reported on substance use disorder referral?

Information such as the individual's substance abuse history, treatment preferences, and contact details must be reported on a substance use disorder referral.