Posted: September 13th, 2017

Co-occurring (substance and emotion for a patient)

Co-occurring (substance and emotion for a patient)
DEMOGRAPHIC INFORMATIONON ACTUAL/TYPICAL CLIENT

Fictional Name:

Age at Admission:

Race:

Sex:

Marital Status:

Employment:

Referral Source:

Current Legal Status:

Admission Date:

Treatment Setting and Modality:
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