| Is the patient’s use or abuse of drugs and/or alcohol causing them moderate to severe impairment?
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| Are there medical, addictive, or psychiatric comorbidities? (e.g. Severe/chronic medical
conditions, use/abuse of addictive drugs/substances, more than one mental health diagnosis). |
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| Does the patient meet moderate of severe criteria for self-harm or suicidal ideation? |
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| Is the patient moderately or severely impaired in their daily functioning? (e.g. Symptoms inhibit
the patient's ability to fully and completely function in their home, work, school, or other daily
environment). |
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| Does that patient experience elevated risk factors for continued use or relapse? (e.g. Addiction,
Serious disruption, conflict, or abuse in the family of social milieu; Overwhelming demands or
stress; exposure to risk factors such as excessive drug or alcohol use; Housing, financial, or other
temporal instability). |
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| Three "Yes" Responses indicate that the client/patient should be referred to the IOP or PHP Program. Discuss with the client/patient and inform them that they meet criteria to be assessed for a higher level of care and document the medical necessity for the referral in the intake note. |
