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