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Clinical Compliance
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Intake Date
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MM
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DD
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YYYY
C#
*
Your answer
Name
*
Your answer
M#
*
Your answer
DOB
*
MM
/
DD
/
YYYY
Diagnostic Code
*
Your answer
Phone
*
Your answer
Initial Treatment (PRP) Plan (10 Days)
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Referral Note
Your answer
Initial SUD Assessment (3 Days)
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Progress Notes (Every other Week)
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UAs (+) (As Needed)
Your answer
Treatment/PRP Plan Review (w/ minutes) Every 90 Days
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Discharges/Aftercare Plan (W/ 3 Days of Exit)
Your answer
SUD (PRP) Group Notes (Within 24 Hours)
Your answer
Clinical Matrix Rollup (Billing Chart)
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DUI Training
Your answer
Referral Note
Your answer
Peer Review Aftercare Plan
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Peer Review Note
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