016.02.91 Ark. Code R. § 001 - Alcohol/Drug Management Information System (ADMIS)
PURPOSE: It is the purpose of this policy to implement the provisions of Act 25 of 1991, enacted by the State of Arkansas 78th General Assembly.
SCOPE: This policy is applicable to ALL persons, partnerships, associations, or corporations operating alcohol and/or other drug abuse treatment programs in the state of Arkansas, whether Accredited by the Division of Alcohol and Drug Abuse Prevention (ADAP) or expressly exempted from Accreditation.
POLICY: In order to provide data for the planning, management, and evaluation of the alcohol and/or other drug abuse treatment and rehabilitation system, all affected programs shall furnish . information prescribed by the ADAP utilizing the Alcohol/Drug Management Information System (ADMIS). In the event it becomes necessary to collect data in addition to the ADMIS, the Division of Alcohol and Drug Abuse Prevention shall prepare ami/or distribute instructions and forms to collect the necessary data, and shall provide such instruction and forms, along with a deadline for submission, to all affected programs. Such programs shall complete and return the data collection forms on or before the established deadline; provided, however, that programs not funded by the Division of Alcohol and Drug Abuse Prevention shall have at least fourteen (14) calendar days to submit data pursuant to such requests.
PREFACE
The Alcohol/Drug Management Information System (ADMIS) is a data collection system developed and operated by the Department of Human Services, Division of Alcohol and Drug Abuse Prevention (ADAP) to be used in alcohol and drug abuse treatment programs in the State of Arkansas. Reporting under this system is a requirement in accordance with Act 25 of 1991 and applies to ALL alcohol or drug treatment programs whether Accredited by the ADAP or expressly exempted from Accreditation.
The purpose of the ADMIS system is to provide current information which describes the clients and the treatment provided to them in order to aid in planning, management, and evaluation of alcohol/drug treatment and rehabilitation programs on both a State and National level. The system is designed to be flexible in order to take into account the wide variety of clients being served by an equally wide variety of programs.
The ADAP is the Single State Agency (SSA) for alcohol and drug programs and welcomes any comments or suggestions for the continued improvement of this management information system.
This Instruction Manual for ADMIS supercedes any previous handbooks and instructions issued prior to July 1, 1991.
The following chapter provides definitions and general instructions relative to the Alcohol/Drug Management Information System CADMIS). Among areas discussed are: who should be reported under ADMIS; descriptions of the ADMIS Reports with information regarding their proper completion and submission; and who to contact for further ADMIS information.
TREATMENT PROGRAM REQUIREMENTS
All alcohol/other drug abuse treatment and rehabilitation programs in Arkansas are required to report client-related data in accordance with the requirements of the current ADMIS. Failure to report may result in the suspension or termination of an ADAP treatment grant or contract and/or loss of ADAP required Accreditation.
Programs Not Required to Report on ADMIS
* Federally funded central intake units that provide no treatment.
* Programs administered by the Department of Defense or the Veterans Administration.
Clients Reported Under ADMIS
Treatment programs required to report on the ADMIS must report on alj alcohol and/or other drug abuse clients in the program.
An exception to this reporting requirement is:
* Family members, community and youth groups, etc., who receive prevention counseling, or other services not defined as treatment services will not be reported as clients.
Submission Schedule
AT 1 Reports for one month from programs to the ADAP Agency are to be postmarked NO LATER THAN THE 7TH OF THE FOLLOWING MONTH. All Reports for one month are to be submitted at the same time. Do not submit Reports for the next month with the current submissions.
The Reports are to be submitted in the following order:
Client Flow Summary
Corrected Copies (CFS)
Current Admission Reports - in chronological order
Late Admission Reports - in chronological order
Corrected Copies (AR)
Environmental Change Reports - in chronological order by date of admission Late Environmental Change Reports - in chronological order by date of admission
Current Environmental Change Reports - in chronological order by date of admission Current Discharge Reports - in chronological order by Item 6 Late Discharge Reports - in chronological order by Item 6 Corrected Copies (DR)
Report Distribution for Copies
The ADMIS reports are to be distributed as follows:
|
COPY |
DISTRIBUTION |
|
1 |
ADAP |
|
2 |
Program |
When a client is transferred or readmitted to any program a photocopy of all ADMIS Reports on that Client should be forwarded to the new unit in order to facilitate ADMIS reporting and to assure that the client's original ADMIS number is retained.
Instructions for Corrected Copies
When previously submitted ADMIS Reports are found to have been incorrect, Correct Copies must be prepared and enclosed with the next submission of Reports. Instructions for the completion of Corrected Copies appear at the end of the specific chapter for each Report.
Leqibilitv
All Reports must be typed or printed in black or blue ink.
When completing ADMIS Reports, press down hard so that entries will be legible on all copies of the Reports. Do not write over mistakes. Rather, cross out the incorrect entry and write the correct entry beside or above the block.
Instruction Manual Format
The following chapters contain specific instructions and definitions for the completion of each ADMIS Report.
The Table of Contents has been designed to facilitate reference to specific Report Items.
Vertical lines have been placed in the right margin to alert the reader to new ADMIS concepts as well as to clarify ADAP policies.
Special Studies Reporting
The ADAP will occasionally conduct special studies that will result in the collection of detailed data. These special studies projects may include, but are not limited to, the study of special population groups, special alcohol/drug problems, and employment status. ADMIS is the primary vehicle used to collect special studies information.
Implementation Instructions
The following implementation instructions pertain to programs that will begin to report on ADMIS for the first time. These programs must implement ADMIS on the budget start date of the treatment grant or contract or on an otherwise designated start-up date.
* An Admission Report must be completed for every client active in treatment prior to the implementation date. (For existing programs only,)
* An Admission Report must be completed for every client admitted to treatment on or after implementation date.
* A Discharge Report must be completed for every client active in treatment on the implementation date who is subsequently discharged from the program.
* A Client Flow Summary must be completed by the program for the month during which the implementation date occurs. A Client Flow Summary must be submitted even if there are no clients in treatment; in this case. Items 4 through 9 should be completed with zeros.
The following instructions pertain to the completion of the Client Flow Summary during the implementation month only:
* Item 4 , Total Reported Clients in Treatment on Last Day of Previous Month, is equal to the number of Admission Reports on which the date entered in Item 4, Date of Admission To This Program, is before the implementation date. Programs with no clients active in treatment before the implementation date [LESS THAN]newly formed programs) must complete this Item with zeros.
* Item 5 , Clients Admitted During Report Month, is equal to the number of Admission Reports on which the date entered in Item 4, Date of Admission to This Program, is on or after the implementation date.
* Item 6 , Clients Admitted During Previous Months, and Item 8, Clients Discharged During Previous Months, should be completed with zeros.
* Monthly logs must be completed by the program for the month during which the implementation date occurs. (See instructions - Monthly Logs.)
Sources of Information
Instructions for submission of completed Reports, requests for training, requests for additional blank forms, questions concerning reporting procedures and policies, and requests for new program identification numbers should be directed to the Records Consultant, ADAP.
Questions concerning ADAP funding or grant/contract specifications should be directed to the Administrative Services Section, ADAP.
You are referred to the ADAP Policies and Procedures Manual. the instructions noted in the Request for Proposal (RFP) package, your current grant or contract, the ADAP Standards Manual for Alcohol and/or Other Drug Abuse/Addiction Treatment Programs, and the "John Doe" sample case record system for additional information, as applicable, to your particular program.
If you have any further questions concerning reporting procedures and policies, or if any exception to the reporting requirements is believed necessary, please write to:
ADAP
P.O. Box 1437 - Slot 2400
Little Rock, AR 72203-1437
(501) 682-6661
Attn: ADMIS
DEFINITIONS AND CODING
DEFINITIONS
Client
For the purpose of this policy, client is a person who has completed the intake and screening process, and has been formally admitted to the program within the standards set by the ADAP and the treatment program.
Co-dependent/Collateral
Co-dependent/Collateral is a person who is making application for or who is a recipient of services due to problems arising from his/her relationship with an alcohol or drug user.
Environment
Environment is the geographic unit in which treatment takes place.
IV/IM Problem or Use
Drug usage where the route of administration is by injection into the muscle or into the vein at any time during the client's drug taking history.
Modality
Modali ty indicates the primary treatment approach or regimen which is assigned to the client by program staff.
Program
A program provides alcohol/drug abuse treatment services directly to clients. The treatment modalities are detoxification, maintenance, drug free, and other. The program environments are prison, hospital, residential, detoxification, day treatment, and outpatient facilities. A single program may provide more than one modality and environment.
Reports
The ADMIS system consists of the following Reports:
* The Admission Report (AR) is to be completed each time a client enters treatment at a program, regardless of the type of admission. The Admission Report provides data on admission status, client characteristics, alcohol/drug problems, and prior treatment.
* The Discharge Report (PR) is to be completed for every client discharged from treatment at the program, regardless of the reason. The Discharge Report provides data on discharge status, client characteristics, alcohol/drug use and time in treatment.
* The Environment Change Report (ECR) is used to report changes in a client's treatment environment.
* The Client Flow Summary (CFS) provides a summary of monthly admission and discharge activities, census of clients by environment, and serves as a transmittal form.
* The Monthly Logs (RR-1 through RR-3 & CCCR) provide a summary of treatment services administered to clients in a program for a one month period. These are the billing forms for reimbursement and are to be completed only by programs funded by the ADAP.
* The Follow-Up Report (FUR) is for use by the program when attempting to determine the present status of clients who are no longer receiving services.
CODING ADMISSION TYPE
This is the first time the client has received alcohol/drug abuse treatment at any program.
The data pertains to the client at the time of first admission. Items 1 through 25 must be completed.
The client has been discharged from any service within this program and is now being readmitted to the same program or any other service within that program. The client is reassigned his/her original client number.
The data pertains to the client at the time of readmission for this current treatment episode. Items 1 through 25 must be completed.
The client has transferred from one ADMIS reporting program to another ADMIS reporting program. Code 3 admission types reflect an uninterrupted treatment episode.
The client has transferred from a non-ADMIS reporting program to an ADMIS reporting program. Code 4 admission types reflect an uninterrupted treatment episode.
CODEPENDENT/COLLATERAL
DRUG TYPES
Methadone obtained and used without a legal prescription.
This includes codeine, Dilaudid, morphine, Demerol, opium, and any other drug with morphine-like effects.
This includes Phenobarbital, Seconal, Nembutal, etc.
This includes methaqualone, chloral hydrate, Placidyl, Doriden, etc.
This includes Benzedrine, Dexedrine, Preludin, methamphet-amine, Ritalin, and any other amines and related drugs.
This includes THC and any other cannabis sativa preparations
Thi s inc1udes LSD, DMT, STP, mescali ne, psi1ocybi n, peyote, etc. (PCP is not included in this code. See code 21 below.)
This includes ether, glue, chloroform, nitrous oxide, gasoline, paint thinner, etc.
This includes aspirin, cough syrup, Sominex, and any other legally obtained, nonprescription medication.
This includes Librium, Valium, Miltown, etc.
This includes any other drug not falling into one of the specified categories.
This includes Sodium processed cocaine, usually administered via smoking.
EDUCATION PARTICIPATION
This includes clients who enter treatment while on vacation from school.
EMPLOYMENT STATUS
Client is not seeking employment. This includes clients who are retired and those adjudged unemployable, (receiving 100% disability benefits from the Social Security Administration. By U.S. Bureau of Labor Statistics definitions, individuals within this code are not considered a part of the labor force.)
Client isseeking employment. This includes clients who have
regi steredwith public or private employment agencies,
respondedto or placed ads, submitted resumes to potential
employers,and those clients who are awaiting start date of a
new job orrecall from layoff.
This includes clients on strike whose past working hours totalled less than 35 hours a week.
This includes clients with part-time jobs that total 35 hours a week or more and clients with concurrent full-time and part-time positions. Clients on strike whose past working hours totalled 35 or more hours a week are also included.
ENVIRONMENT
The client is incarcerated in a Federal, State, or other prison or jail and participates in a treatment program within the correctional institution.
The program's funded environment may not be prison, but regularly scheduled treatment services are being provided by program staff in a prison environment.
If the cl ient is leaving the prison on a regular basis to receive alcohol/drug abuse treatment services from a program outside the prison, enter the environment as either day treatment or outpatient.
A hospital or residential detoxification setting where the client resides and is being treated primarily for alcohol/drug abuse problems. The client may, in addition, be receiving services for medical and/or psychiatric/psychological problems.
An alcohol/drug abuse treatment unit where the client resides other than a prison or hospital. Alcohol/drug treatment therapeutic communities are included in this code.
When alcohol/drug treatment services are provided to a client who resides in a non-alcohol/drug related residential setting, enter the environment as either day treatment or outpatient.
The client resides outside the program. The client participates in an alcohol/drug abuse treatment program, with or without medication, according to a minimum attendance schedule as defined by the ADAP. Services provided may include individual, group, and family counseling; job development, and/or educational and legal services. Day Treatment must contain 4 1/2 hours of structured treatment per day.
The client resides outside the program. The client participated in an alcohol/drug abuse treatment program, with or without medication. The client attends the program according to a predetermined schedule for services that includes counseling and supportive services.
Outpatient differs from Day Treatment in that the client usually attends the program less frequently and may not have regularly assigned and supervised work functions at the program.
The client resides in a hospital facility licensed as such by the Arkansas Department of Health.
FREQUENCY OF USE
HEALTH INSURANCE STATUS
The client does not have private or public health insurance.
MARITAL STATUS
This includes the client whose marriage has been annulled.
This includes the client who is legally married, married by common-law, and the client who considers himself/herself married.
This includes the married client not 1iving with spouse by choice, whether or not a court has entered a decree of legal separation.
MODALITY AT ADMISSION
The primary treatment modality that is the period of planned withdrawal from alcohol/drug dependency supported by use of a prescribed medication.
The primary treatment modality assigned to the client during which Disulfiram is prescribed to achieve stabilization.
The primary treatment modality that does not include any chemical agent or medication as the primary part of the alcohol/drug treatment.
Temporary medication may be prescribed (for example, short-term use of tranqui1izers) but the primary treatment method is traditional counseling (individual, group, etc.). This may/should include educational experiences, as a part of treatment, for the client. This includes withdrawal without medication.
The primary treatment modality assigned to the client that is other than those specified above.
MODALITY AT TIME OF DISCHARGE
The primary treatment modality that is the period of planned withdrawal from alcohol/drug dependence supported by use of a prescribed medication.
The primary treatment modality assigned to the client during which disulfiram is prescribed to achieve stabilization.
The primary treatment modality that does not include any chemical agent or medication as the primary part of the alcohol/drug treatment.
Temporary medication may be prescribed (for example, short-term use of tranquilizers) but the primary treatment method is traditional counseling (individual, group). This may/should include educational experience for the client as a part of treatment. This includes withdrawal without medication.
The primary treatment modality assigned to the client that is other than those specified above.
OCCUPATION
PRESCRIBED MEDICATION
Trade Name: Oarvon-N
Antagonist prescribed as the primary medication.
Antagonist prescribed as the primary medication.
Trade Name: Antabuse
Prescribed as the primary medication during alcohol abuse treatment.
For example: Nalorphine, Levallorphan
Antagonist prescribed as the primary medication.
A medication not listed above that is prescribed as a primary part of the client's treatment regimen.
RACE
A Caucasian person having origins in any of the people of Europe (includes Portugal), North Africa, or the Middle East.
A person having origins in any of the people of sub-Saharan Africa (includes Haiti).
A person having origins in any of the original people of North America.
A person having origins in any of the original people of North America.
A person having origins in any of the original people of the Far East, Indian Subcontinent, Southeast Asia, or the Pacific Islands.
A person of Mexican origin, regardless of race.
A person of Puerto Rican origin, regardless of race.
A person of Cuban origin, regardless of race.
A person from Central or South America and all other Spanish cultures and origins, regardless of race (includes Spain).
NOTE: If a client is racially mixed, enter the code for the race/ ethnic background with which he/she identifies.
REASON FOR DISCHARGE
The client has no alcohol/drug problems and has not used alcohol/drugs during the 30 days prior to discharge.
The client has no alcohol/drug problem but has used a drug(s) during the 30 days prior to discharge.
The client is discharged from the program and is transferred for continued treatment to another ADMIS reporting program. Treatment has not been completed.
The client is discharged for violation of program rules. (For example, for continued alcohol/drug involvement, etc.) Treatment has not been completed.
Ttie client is discharged because of his/her decision to leave the program before completion of treatment or his/her refusal to continue a further phase of treatment. Treatment has not been completed.
The client is discharged because of incarceration. Treatment has not been completed.
The client is discharged because of death.
REFERRAL
This includes a medical or psychiatric hospital, or affiliated programs.
This includes a Federal, State, or local agency that provides aid in the areas of poverty relief, unemployment, or social welfare; another alcohol/drug program; and a private physician, psychiatrist, or other mental health professional. Referrals from the Veteran's Administration, if the program does not use V.A. funds, are included under this code.
This includes a supervisor or an employee counselor.
This includes a school principal, counselor, or teacher.
This includes a public defender, defense attorney, and any other voluntary referral sources not listed in codes 01-07.
The client has not served a term in a correctional institution for this offense.
This includes referrals from a judge, prosecutor, probation officer or other personnel affiliated with the Federal, State, Municipal, and/or county/court judicial system.
This also includes clients who have been referred in lieu of or for deferred prosecution, and pretrial release, before or after official adjudication. The client need not be officially designated as "on probation."
The client haj[GREATER THAN] served a term in a correctional institution.
This includes a warden, superintendent, parole officer or other personnel affiliated with the Federal, State, and/or county jail or prison system.
This also includes clients on preparole, prerelease, work and/or home furlough. The client need not be officially designated as "on parole."
Usually a commitment under Act 10 of 1989 or similar civil commitment.
ROUTE OF ADMINISTRATION
Absorbed through the lungs and respiratory system by mouth.
Administered by injection into the muscles.
Administered by injection into the veins.
SEVERITY OF PROBLEMS
SEX
ADMIS
ADMISSION REPORT
An Admission Report (AR) is completed for every client admitted to the program for alcohol/drug treatment whether as a first admission, readmission, or a transfer admission from one program to another program.
The Admission Report collects information on the client's sociodemographic characteristics, treatment history, treatment plan components, and alcohol/drug abuse history.
In cases where a client is receiving concurrent alcohol treatment services in more than one program, the client should be reported by the program which has the responsibility for the client's total treatment plan and where the client's primary counselor is located.
The codes are listed on the back of the Admission Report.
The seven-digit Program Identifier is assigned by ADAP to each program. This number is to be used on all ADMIS reports. The Program I.D. Number is assigned on a permanent basis to each program.
As of August 1, 1988, any client which is admitted will be assigned a "Client Number" in the manner described as follows:
"0" + Social Security Number
All clients admitted after August 1, 1988, will have a "Client Number" assigned using the above procedure even if they have had an "ADMIS Number" previously assigned.
Enter the actual SSN as provided by the client. Whenever possible this should be obtained from a document (Social Security Card, Driver's License, VA Hospital ID Card and United States Armed Services ID).
If the client has no SSN, DHS' Policy #1032 must be followed for the assignment of a pseudo-SSN (See Appendices.)
Please note the following definitions for future reference:
"ADMIS Number" - the number assigned to clients based on the two-digit code of the program assigning the number, client's date of birth and the day of the month the client was admitted.
"Client Number1"- "0" + the client's Social Security Number
Any clients which are still "active" (not discharged) as of August 1, 1988, will continue to use the "ADMIS Number" previously assigned until they are discharged.
When a client is discharged after August 1, 1988, and then re-admitted to any Provider, the client will be assigned a "Client Number" ("0" + Social Security Number). If a client is admitted after August 1, 1988, who was assigned an "ADMIS Number" prior to August 1, 1988, they will be assigned a "Client Number". BE SURE TO UPDATE CLIENT FOLDERS, CROSS REFERENCE SYSTEMS, ETC., TO REFLECT THE NEW "CLIENT NUMBER" INSTEAD OF THE OLD "ADMIS NUMBER".
Enter two digits each for month, day, and year. All Items requiring dates are completed in this manner.
Enter the date the client received his/her first face-to-face treatment contact. All intake and screening processes are to have been completed and a treatment regimen assigned. The date of admission for a transfer admission is the actual date the client receives his/her first face-to-face treatment contact.
If a cl ient is admitted who has previously been assigned an "ADMIS Number" (see above definition), that number is to be entered in Item #4. The client will be admitted for this admission using a "Client Number".
Enter one of the sex codes to indicate the client's sex at the time of admission.
Is seeking services due to problems arising from his/her relationship with an alcohol or drug user? This applies only to those persons who are not yet clients; or
Has been formally admitted for treatment (services) and the alcohol or other drug abuser is not an admitted client. This client has their own separate record; or
Has his/her own client record within another primary client record. Services are billed under another client's number.
NOTE: Those individuals whose AR is marked 1 or 3 on Item 5-A will not complete the following AR items: 4; 9; 11; 13; 16; 17; 19; 20; 21; 23 and SSN verification. All items on the AR (including SSN Verification) will be completed if Item 5-A is marked with a 2.
Based on staff observation and client self-identification, enter one of the race codes which have been selected to conform with the Office of Federal Statistical Policy and Standards, U.S. Department of Commerce.
Enter two digits each for month, day, and year of birth. If the exact date is unknown, estimate as closely as possible and enter the approximate data. Enter 00 for years prior to 1900.
Enter one of the admission codes to indicate the type of admission.
Enter the modality code which indicates the primary treatment approach or regimen which was assigned to the client by program staff and which was mutually agreed upon as the treatment plan at the time of admission.
If a client is receiving concurrent alcohol/drug treatment services in more than one program, the client should be reported by the program which has the responsibility for the client's total treatment plan and where the client's primary counselor is located.
Enter the environment code which indicates the treatment environment actual1y experienced by the client immediately upon admission, as assigned by the program staff.
If a client is receiving concurrent treatment services, the environment should reflect where the client spends the greatest amount of time.
Enter one of the occupation codes to indicate the type of occupation as identified by the client. (Definitions are in the Appendices.)
Enter one of the referral codes to indicate the agency, individual, or legal situation through which the client is committed or referred to treatment.
Codes 01-08 indicate sources of referral that are of a voluntary nature. Codes 09-12 indicate sources of referral that are of a legal or non-voluntary nature.
When thereis a combination legal and self or private referral, the legal
commitmenttakes priority over the other sources. Unique codes for
Bureau ofPrisons and Veterans Administration clients are contained elsewhere.
Enter the marital code to indicate the client's marital status at the time of admission.
Enter the employment status code which indicates if the client is employed (includes self-employment) or unemployed at the time of admission. (Definitions for these codes are consistent with those of the U.S Bureau of Labor Statistics.) To qualify as being employed, the client's earnings must be subject to income taxes. For example, stipends and welfare payments are not taxable; therefore, the client whose sole source of income is derived from these monies would not be considered employed. Income through illegal drug sales is not considered legal employment.
Enter the highest school grade completed by the client at the time of admission. The codes range from 00 for none to 20. If more than 20 years of school have been completed, enter code 20.
Complete both blocks, with a leading zero if necessary. For example, if a client has completed the eighth grade, 08 should be entered. A G.E.D. or high school equivalency should be entered as 12.
Enter the education code to indicate whether the client is attending an educational or skill development program on a full or part-time basis at the time of admission.
Participation in an educational program is attendance at a school or college from which the client will receive a diploma or degree. High school equivalency programs are included. On the Job Training (0JT) is considered to be participation under this Item as is enrollment as a client under Rehabilitation Services.
Participation in a skill development program provides the client with vocational training (for example, clerk, barber, or mechanic).
Enter the number of times the client was arrested and booked during the
12 months prior to admission. The codes range from 00 for none to 96.
If a client was arrested and booked more than 96 times, enter code 96.
Complete both blocks, with a leading zero if necessary. Arrests do not have to be only alcohol/drug related to be included in this Item.
This Item does not imply conviction and related to a!leged offenses committed during the 12 months prior to the client's Date of Admission to This Program (Item 4).
Do not include arrests for traffic offenses. Arrests for driving while under the influence of alcohol or drugs, however, should be included.
Enter the number of admissions and readmissions to any alcohol/drug treatment program that occurred prior to this admission or readmission. The codes range from 00 for none to 96. If a client has had more than 96 prior admissions, enter code 96. Complete both blocks, with a leading zero if necessary.
Prior admissions or readmissions to this program are included; consequently, at least one prior admission will be recorded in this Item if Item 5, Admission Type, is code 2.
Do not count transfer admissions within the program in this Item.
Enter the number of months that have elapsed since the client was last discharged from alcohol/drug treatment prior to the current admission. The codes range from 00 for none to 96. If more than 96 months have elapsed, enter code 96. Complete both blocks, with a leading zero if necessary.
Count any portion of a month as a full month. For example, 2 weeks should be entered as 01; 6 months and 1 week should be entered as 07.
Enter 00 if the client has had no lapse in treatment. For example, if the client has been referred to your program through a formal agreement (written or oral) with the referring program, 00 would be entered to indicate no lapse in treatment.
If the client has had no prior discharges from this or any other drug treatment program (code 00 has been entered in Item 18, for Not Applicable must be entered.
Determine if the client has health insurance at the time of admission to this program, not whether alcohol/drug treatment is specifically covered by the client's insurance.
A juvenile client covered by his/her parents' health insurance is recorded as having health insurance. Enter the appropriate code.
Enter the three digit county code corresponding with the county in which the client resides. The county code in which the client is being treated is not to be used unless the client resides 1n the same county in which the treatment is provided. County Codes are provided in the Appendices.
ALCOHOL/DRUG MATRIX (ITEMS 22-26)
Alcohol/Drug Pattern At Admission
Items 22-26 comprise the alcohol/drug matrix. In order to complete the alcohol/drug matrix, it is important to know that ADMIS distinguishes between chemical substances that are problems and those that were merely used during 30 days prior to admission.
Characteristics of Problem Drugs and Alcohol
* Cause physical, mental, or social dysfunction.
* Can include any drug type as listed in Item 22.
* Have not necessarily been taken by the client during the 30 days prior to admission.
Characteristics of Use Drugs
* Are recorded only if space allows, and after problem alcohol/drugs have been entered.
* Cause no dysfunction.
* Have been used by the client during the 30 days prior to admission.
* Can include alcohol (if not the primary problem), over-the-counter drugs abused, or legally prescribed drugs not taken as directed.
* Are ranked as Use (Not a Problem), Code 0, in Item 24.
.In determining the severity of alcohol/drug problems, the following considerations should be made:
* patterns of alcohol/drug involvement;
* degree of present or past physical, mental, or social dysfunction caused by alcohol/drug involvement; and
* degree of present or past physical or psychological dependence on alcohol/drug, regardless of the frequency of use.
Each client's alcohol/drug problem(s) is to be individually assessed. Do not compare one client's pattern of alcohol/drug involvement with that of another client.
From the drug type codes, identify and enter the drug(s) which causes the client's dysfunction at the time of admission - problem drug(s). Identify any drug used intravenously/intramuscularly at any time during the client's drug taking history. A DRUG TYPE MUST BE INDICATED.
Then, if space allows, and after all problem drugs have been entered, identify and enter the drug(s) which the client has used during the 30 days prior to admission - use drug(s).
After all problem and jjs_E drugs have been entered, complete any remaining blocks with zeros. All blocks must be completed.
Enter 00 for none if the client has no secondary or IV/IM drug problem and has not used a drug during the 30 days prior to admission. When 00 for none is entered in any blocks of this Item, leave the corresponding blocks of Items 23-26 blank.
In alcohol treatment programs, (Code 04 Alcohol) will be listed as the primary problem in most cases. However, some clients may be involved with drugs as well. Therefore, if applicable, information regarding use of drugs, other than alcohol, must be recorded.
EXAMPLE - A client who has a primary problem of Amphetamine, a secondary problem of marijuana, and a tertiary problem of tranquilizers will show an abuse pattern as shown in the example:
PLACE CODES OF DRUG HERE
|
ALCOHOL/DRUG PATTERNS AT ADMISSIONS |
PRIMARY PROBLEM OR USE |
SECONDARY PROBLEM OR USE |
IV/IM PROBLEM OR USE |
|||
|
22. ALCOHOL/ DRUG TYPE(S) Complete all blocks) |
||||||
|
0 |
7 |
0 |
9 |
0 |
1 |
|
From the severity codes, rank and record the severity for each drug type identified in Item 22. Note that Item 23 is subjective. A high degree of coordination must be maintained between the treatment staff and the person(s) reporting on ADMIS to insure the most accurate and descriptive severity code(s) is used.
Enter one of the codes to indicate the frequency of alcohol or drug use during the 30 days prior to admission for each drug type recorded in Item 22. If more than one frequency exists, enter the highest frequency.
If a use drug, code 0, Use [LESS THAN]Not A Problem), was recorded in Item 22, a frequency greater than 0 must be entered.
When 00 for none has been entered in any blocks of Item 22, Drug Type(s), leave the corresponding blocks of Item 24 blank.
Enter one of the following codes to indicate the client's most recent usual route of administration at the time of admission.
If more than one route of administration exists, enter the most frequent route.
When 00 for none has been entered in any blocks of Item 22, Drug Type[LESS THAN]s), leave the corresponding blocks of Item 25 blank.
Enter the last two digits for the year to indicate when the client first became involved on a regular basis in the alcohol/drug type(s) identified in Item 22.
If the exact year is unknown, estimate as closely as possible.
When 00 for none has been entered in any blocks of Item 22, Drug Type(s) leave the corresponding blocks of Item 26 blank.
First use does not include incidental or irregular sampling provided by a parent. Rather, first use includes initiation of use on one's own or regular supply by others.
For IV/IM use, enter the year that the client first utilized this route of administration.
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ADMIS
ENVIRONMENT CHANGE REPORT
An Environment Change Report or ECR Is to be completed on those active clients within a program who, during the course of treatment, move from one type of treatment environment to another. There are five (5) service environments defined by the ADAP, Detoxification Unit, Residential Unit, Day Treatment Unit, Outpatient Unit and Hospital.
An active client may need to be moved on more than one occasion in order to provide the most effective treatment. This is acceptable; however, an ECR must be completed for each change. This report is to be used for active clients only.
The ECR is to be used to verify billing activities for the various active clients and to assess contracted capacity levels for each funded program.
Further instructions for the completion of each item on the ECR form follow:
The seven digit Program Identifier is assigned by ADAP to each program. This number is to be used on all ADMIS Reports.
Enter the actual date the Environment Change Report is completed. This serves as the identifier for purposes of correspondence and corrections.
Enter two digits each for the month, day, and year. Enter a number in each block; use zero [LESS THAN]0) when appropriate. All Items requiring dates are completed in this manner.
For example, January 1, 1991, should be entered: I 01 11 0| 11 9| T|
Place either the Client Number or the ADMIS Number in this area. If the client was admitted 8/1/88 or after it should be a "Client Number". If the client was admitted prior to 8/1/88 and has not been discharged it should be an "ADMIS Number".
BE SURE TO USE THE CORRECT NUMBER IF THE CLIENT HAS BOTH A "CLIENT NUMBER" AND AN "ADMIS NUMBER"-
At top of the form next to Alcoho]/Drug Management Information System (ADMIS) check whether client's primary problem is alcohol or drug.
Enter the date of admission as listed on the client's Admission Report (Item 4 on the AR).
Place a check by only one of the categories to indicate the treatment environment actually experienced and completed by the client at the time specified under Item 5 as assigned by the program staff.
If "DETOXIFICATION" was checked under Item 5, enter the date of the last full 24 hour period during which the client was in the Detoxification environment.
If "RESIDENTIAL" was checked under Item 5( enter the date of the last full 24 hour period during which the client was in residence.
If "DAY TREATMENT" was checked under Item 5, enter the date of the last day the client received day treatment services.
If "OUTPATIENT" was checked under Item 5, enter the date of the last face-to-face treatment contact here.
If "HOSPITAL" was checked under Item 5, enter the date of the last full 24 hour period the client was in the hospital environment.
Enter two digits each for month, day, and year. All Items requiring dates are completed in this manner.
Place a check by only one of the following definitions to indicate the treatment environment actually entered by the client at the time specified under Item 8, as assigned by the treatment staff.
If "DETOXIFICATION" is used under Item 7, enter the date of the first full 24 hour period during which the client was in the Detoxification environment.
If "RESIDENTIAL" was checked under Item 7, enter the date of the first full 24 hour period during which the client was in residence.
If "DAY TREATMENT" is used under Item 7, enter the date of the first treatment day in the Day Treatment environment.
If "OUTPATIENT" was checked under Item 7, enter the date of the first face-to-face treatment contact here.
If "HOSPITAL" was checked under Item 7, enter the first full 24 hour period during which the client was in the hospital environment.
Enter two digits each for month, day, and year. All items requiring dates are completed in this manner.
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*Note: Date entered here is:
Hospital/Detoxification/Residential - First 24 hour day at
facility
Day Treatment/Outpatient - First treatment session in which the
client participates
ADMIS
DISCHARGE REPORT
A Discharge Report (DR) Is completed for every client discharged from treatment. Thereupon, the program staff no longer has clinical or administrative responsibility for the client's alcohol/drug treatment.
The Discharge Report collects information on the client's sociodemographic characteristics, discharge status, alcohol/drug use at discharge, and time in treatment.
For every client on whom an ADMIS Admission Report has been submitted, a Discharge Report must be completed.
A client who has been admitted to treatment, but has not received a face-to-face treatment contact within the last 30 days shall be removed (discharged) from the ADMIS system.
The seven - digit Program Identifier is assigned by ADAP to, each program. This number is used on all ADMIS Reports. The Program I.D. Number is assigned on a permanent basis to each program.
Enter the actual date the Discharge Report is completed. This serves as the Discharge Report identifier for purposes of correspondence and Corrected Copies.
Enter two digits each for the month, day, and year. Enter the number in each block, use zero (0) when appropriate. All items requiring dates are completed in this manner.
For example, January 1, 1991, should be entered: Mo. Day Year
0111 on |9TT|
Put either the "Client Number" (Social Security Number) or the "ADMIS Number" for that client in this location.
IF THE CLIENT HAS A PREVIOUS "ADMIS NUMBER" AND A "CLIENT NUMBER", BE SURE TO USE THE "CLIENT NUMBER"!
Record the date the client received his/her last face-to-face treatment contact.
Enter two digits each for month, day, and year.
Unless program rules dictate a shorter period of time, a client must be discharged from ADMIS if he/she has not received a face-to-face treatment contact at least once in a 30-day period.
All data pertain to the client as of the last face-to-face treatment contact.
Enter the client's Social Security Number (actual or pseudo) as it was entered on the Admission Report.
Enter the date as it appears in Item #3 of the Admission Report for the current admission.
NEVER put the admission date of a previous admission or an environmental change.
Enter the following code to indicate the reason for discharge from the reporting program. All data pertain to the client at the time of his/her last face-to-face treatment contact (Item 4, Date of Discharge From This Program).
Enter the following code to indicate the primary treatment approach or regimen experienced by the client at the time of his/her last face-to-face treatment contact (Item 4, Date of Discharge from this program).
If a client is receiving concurrent alcohol/drug treatment services in more than one program, the client should be reported by the program which has the responsibility for the client's total treatment plan and where the client's primary counselor is located.
Enter one of the codes to indicate the treatment environment actually experienced by the client at the time of his/her last face-to-face treatment contact (Item 4, date of discharge from this program).
If a client is receiving concurrent treatment services, the environment should reflect where the client spends the greatest amount of time.
Enter one of the codes to indicate the type of medication that has been prescribed for the client by authorized personnel. This should indicate the medication being used by the client at the time of his/her last face-to-face treatment contact.
This does not include medication prescribed for medical problems at time of discharge.
Enter the code which indicates the client's participation in Continuing Care.
Enter the code to indicate whether the client is legally employed (includes self-employment) or unemployed at the time of discharge.
Enter the highest school grade completed by the client at the time of discharge. The codes range from 00 for none to 20. If more than 20 years of school have been completed, enter code 20.
Complete both blocks, with a leading zero if necessary. For example, if a client has completed the eighth grade, 08 should be entered. A G.E.D. or high school equivalency should be entered as 12.
Enter the code to indicate if the client is attending an educational or skill development program on a full or part-time basis at the time of discharge.
Enter the number of times the client states he or she was arrested and booked during his/her current treatment episode.
This is the client's primary residency county code (if the client has a permanent residency). This can be different than it was on the Admission Report if the client has moved their place of residency. County codes are provided in the Appendices.
ALCOHOL/DRUG MATRIX (ITEMS 17-20)
Alcohol/Drug Patterns at Discharge
Items 17-20 comprise the alcohol/drug matrix. In order to complete the alcohol/drug matrix, it is important to know that ADMIS distinguishes between chemical substances that are problems and those that were merely used during the 30 days prior to discharge.
Characteristics of Problem Drugs/Alcohol
* Cause physical, mental, or social dysfunction.
* Can include any drug type as listed in Item 17.
* Have not necessarily been taken by the client during the 30 days prior to discharge.
Characteristics of Use Drugs
* Are recorded only if space allows, and after problem drugs have been entered.
* Cause no dysfunction.
* Have been used by the client during the 30 days prior to discharge.
* Cannot include alcohol, over-the-counter drugs, or legally prescribed drugs taken as directed.
* Are ranked as Use (Not a Problem), code 0, in Item 18.
In determining the severity of alcohol/drug problems, the following consideration should be made:
* patterns of alcohol/drug involvement;
* degree of present or past physical, mental, or social dysfunction caused by alcohol/drug involvement; and
* degree of present or past physical or physochological dependence on alcohol/drug, regardless of the frequency of use.
Each client's alcohol/drug problem(s) is to be individually assessed. Do not compare one client's pattern of alcohol/drug involvement with that of another client.
From the codes, identify and enter the drug(s) which caused the client's dysfunction at the time of discharge - problem drug(s).
Then, if space allows, and after all problem drugs have been entered, identify and enter the drug(s) which the client has used during the 30 days prior to discharge - us_e drug(s). If a client was in treatment less than 30 days, enter any drug(s) used during that time in treatment.
After all problem and us_e drugs have been entered, completed any remaining blocks with zeros. All blocks must be completed.
Unless there has been a change in the client's drugs of use during the 30 days prior to discharge, the drugs listed on Item 17 will follow the same pattern as Item 22 on the ADMIS Admission Report.
From the following codes, rank and record the severity for each drug type(s) identified in Item 17.
Problem drugs are ranked from left to right. A primary drug problem is entered in the far-left column. A secondary drug problem is entered in the center column. An IV/IM drug problem is entered in the far-right column. After problem drugs have been entered, and if space allows, record any ujse drug(s).
When 00 for none has been entered in any blocks of Item 16, Drug Type(s), leave the corresponding blocks of Item 17 blank.
If the drug type[LESS THAN]s) for polydrug abusers cannot be identified as primary, or secondary, rank and record the drugCs) in order of the client's choice.
Again, as with the Admission Report, proper coordination must take place between the clinical/counseling staff and the person(s) completing the report to insure that the most appropriate code is placed in item 18.
Enter the applicable code that closest described the frequency of use, for each drug type listed in Item 17, during the 30 days prior to discharge.
If there is no drug listed in Item 17 enter 0.
Enter one of the following codes to indicate the client's usual route of administration within 30 days prior to discharge.
If more than one route of administration exists, enter the most frequent route.
When 00 for none has been entered in any blocks of Item 17, Drug Type(s), leave the corresponding blocks of Item 20 blank.
CORRECTED COPIES
ALL CORRECTED COPIES MUST BE SUBMITTED ON ADMIS FORMS. SUBMISSIONS ON ANY OTHER FORMS WILL NOT BE ACCEPTED BY THE ADAP.
Corrected copies are used to correct errors made on previously submitted Discharge Reports. The state, or program may initiate submission of a Corrected Copy if data contained on a previously submitted Discharge Report is discovered to be incorrect.
Complete the Item in the following manner:
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Purpose: The purpose of continuing care services is to provide the treatment facilities a means whereby services delivered to former clients can be billed to the DHS-ADAP as match services.
Clients, in order to be eligible for continuing care, must meet all of the following requirements:
CIients enrolled in continuing care must be removed from continuinq care within 365 calendar days after their most recent ADMIS discharge (Item 4 on the discharge report). The treatment program does have the option of removing the client from continuing care prior to the 365 day, post discharge, cut-off date.
Example - Client John Doe was discharged from an alcohol treatment program's outpatient program with an 01 (Item 7) code on his discharge report. Mr. Doe's ADMIS discharge date (Item 4 on the DR) was 9-20-89. The program can keep Mr. Doe in the continuing care status until 9-19-90 unless the program decides to remove Mr. Doe prior to the 9-19-90 removal date.
PROCEDURES FOR ENROLLMENT INTO CONTINUING CARE
Step 1 - Program decision to enroll client into continuing care prior to or at the time of discharge.
Step 2 - Continuing care marked yes (Item 11, Code 1) on the client's discharge report.
Step 3 - Client receives continuing care services (if client does not receive continuing care services within 365 days after discharge go to Step 7).
Step 4 - Services are documented via progress notes in the client's record. If needed, the client's aftercare plan is modified and/or evaluated.
Step 5 - Continuing care services provided to each client during the month are recorded on the Continuing Care Contact Report (CCCR). Consult the instructions on the completion of the CCCR.
Step 6 - The CCCR(s) is attached to the monthly billing that is submitted to the ADAP.
Step 7 - Client removal from continuing care services will occur due to one (1) or more of the following four reasons:
Step 8 - Removal from continuing care documented in client record.
Step 9 - Removal date from continuing care entered on CCCR.
INSTRUCTIONS FOR THE COMPETITION OF THE CONTINUING CARE CONTACT REPORT (CCCR)
NOTE - Separate CCCR's must be used to show Title XX match and OADAP match.
Example - The Easy Does It, Inc. Alcohol Treatment Program (1) is submitting their CCCR's for the month of October, 1986. (2) The program decided to apply the continuing care services to their ADAP match. (3) Client 7004126317, whose most recent ADMIS Admission and Discharge 6-17-86(5) and 9-4-86(6) respectively, received one-half hour of individual counseling and one hour of group counseling (8). Client 7002045107 [LESS THAN]9), admitted 7-7-86(10) and discharged on 8-10-86(11), received one hour of individual counseling (12). Client 5111214830, (14) and discharged on 5-4-86(15) received 2 hours of group counseling (16). Client 7006113722 (17) admitted on April 7, 1986 (18) and discharged on June 15, 1986 (19) was removed from continuing care services on October 21, 1986 (20) due to the client moving out of state. Client 7012054216 (21), admitted 5-2-85(22) and discharged on 10-10-85(23) was removed from continuing care on 10-09-86(21) since 365 days had expired since his most recent discharge. The Easy Does It, Inc. provided 1.5 hours of individual counseling (ADAP match) (22) and 3 hours of group counseling (ADAP match) (23) during October, 1986.
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INSTRUCTIONS
CLIENT FLOW SUMMARY
/0 /9 /0 /0 /0 /5 /5 /
/0 /I /I /0 /9 /0 /
/0 /0 /I /
Detoxification Unit /0 /0 /I /
Residential Unit /0 /0 /8 /
Day Treatment Unit /0 /0 /9 /
Outpatient Unit /0 /I /I /
Hospital /0 /0 /0 /
*TOTAL 10 II IS I
*The total here MUST match the total in Item #9.
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THE FOLLOWING CHAPTERS APPLY TO ADAP FUNDED PROGRAMS ONLY - ALL OTHER PROGRAMS ARE NOT REQUIRED TO SUBMIT FORMS ON THE FOLLOWING CHAPTERS.
INSTRUCTIONS FOR COMPLETING THE REIMBURSEMENT REQUEST FORMS RR-K RR-2 & RR-3..THESE FORMS ARE FOR USE WITH CONTRACT OR GRANT REIMBURSEMENTS.
In requesting reimbursement from ADAP, the sub-contractor must use three reimbursement forms. Form RR-1 is the ADAP Contract Reimbursement Request and Certification Form and Form RR-2 is the Financial Statement of Account. These forms, an original and one copy, are to be submitted monthly. These forms must be submitted along with the Client Log Sheets, Form RR-3, which will be used to substantiate the amounts shown on the RR-2. Proper completion of these reimbursement forms will assure prompt payment to the sub-contractor.
Form RR-1
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Form RR-2
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Form RR-3
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FOLLOW UP REPORT (FUR) FORM
Instructions for Completion
This form is designed for use by the treatment program when efforts are made to "follow up" on the progress being made by clients who are no longer actively involved in treatment. These forms are to remain at the treatment program and, upon completion, should become a part of the client's treatment record.
ADMIS Admission Form.
FOLLOW UP REPORT CONTINUED
RANDOM SELECTION - The FUR must be completed on at least 10% of all discharged. However, it is strongly recommended that all clients are included in the follow up service. The 10% sample is a minimum requirements.
PROGRAM RECORDS - The FUR's are designed to be incorporated into the records system of each program. Follow Up Records do not have to be submitted to the ADAP. As part of the ADAP program monitoring, the FUR's will be reviewed by the ADAP staff during site visits.
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APPENDICES
ALCOHOL/DRUG MANAGEMENT INFORMATION SYSTEM (ADMIS) PROGRAM IDENTIFIERS
|
PROGRAM IDENTIFIER |
NAME OF PROGRAM |
|
D10225 |
Ozark Counseling Associates |
|
D12031 |
215 Club, Inc., - Decision Point |
|
D14714 |
Ozark Mountain Alcohol Residential Treatment, Inc. (OMART) |
|
D20332 |
North Arkansas Human Services System, Inc. (NAHSS) |
|
D22111 |
Northcentral Arkansas Development Council CNADC) |
|
D32213 |
Black River Area Development Corporation (BRAD) |
|
D32334 |
East Central Arkansas - E.D.C. |
|
D32431 - 1 |
CROWLEY'S RIDGE DEVELOPMENT COUNCIL (CRDC) |
|
D32431 - 2 |
Northeast Arkansas Regional Recovery Center |
|
D3243! - 3 |
Sobriety and Beyond |
|
D32431 - 4 |
Northeast AR. Women's Recovery Center |
|
D41522 |
Southeast Arkansas Mental Health Center |
|
D41836 |
Delta Counseling Associates |
|
D44335 |
ARKANSAS DEPARTMENT OF CORRECTIONS |
|
D44335 - 1 |
Cummins Unit |
|
D44335 - 2 |
Tucker Unit |
|
D44335 - 3 |
Women's Unit |
|
D44335 - 4 |
Wrightsville Unit |
|
D44335 - 5 |
Benton Work Release/Pre-release |
|
D44335 - 6 |
Luxora Facility (Mississippi County) |
|
D44335 - 7 |
Texarkana Facility |
|
D44335 - 8 |
Varner |
|
D44335 - 9 |
Tucker Max |
|
044831 |
HUMAN DEVELOPMENT AND RESEARCH SERVICES |
|
D44831 - 1 |
Christopher House |
|
D44831 - 2 |
Human Development & Research Services |
|
D44831 - 3 |
Star City Satellite Office |
|
D44831 - 4 |
Sheridan Satellite Office |
|
D51023 |
Family Services Agency |
|
D54631 |
CENTRAL ARKANSAS SUBSTANCE ABUSE PROGRAMS, INC. (CASAP) |
|
D54631 - 1 |
Counseling Clinic |
|
D54631 - 2 |
Serenity Park |
|
D54631 - 3 |
Riverbend Recovery Center |
|
D54631 - 4 |
Twenty-Four Hour Center - Men |
|
D54631 - 5 |
Twenty-Four Hour Center - Women |
|
D54631 - 7 |
Gyst House |
|
D54631 - 8 |
Lonoke County Center |
|
D55134 |
Benton Detoxification Services Center |
|
D55232 - 1 |
Alexander Youth Services Center (Chemical Dependency) |
|
D55232 - 2 |
Pine Bluff Youth Services Center |
|
D60634 |
Counseling Associates |
|
063813 |
Arkansas River Valley.Area Council (ARVAC) |
|
D64431 |
Quapaw House |
|
D71732 |
South Arkansas Regional Health Center |
|
D74031 |
Red River Council on Alcohol and Drug Abuse |
|
080533 |
Western Arkansas Counseling and Guidance Center |
|
D83231 |
Harbor House, Inc. |
|
D84112 |
Gateway House |
|
090001 |
Charter Vista Hospital (Fayetteville) |
|
D90002 |
Baptist Memorial Hospital - Crosspoint |
|
D90003 |
Crittenden Memorial Hospital - Koala Center |
|
D90004 |
Greenleaf Center, Inc. |
|
D90005 |
Jefferson Regional Medical Center - First Step Chemical Dependency Unit |
|
D90006 |
Arkansas Rehabilitation Institute - Recover Careunit |
|
D90007 |
Charter Hospital of Little Rock |
|
D90008 |
Restore - St. Vincent Medical Center |
|
D90O09 |
Hot Spring County Memorial Hospital - Chemical Dependency Youth Center |
|
D90010 |
Ouachita County Hospital - Chemical Dependency Unit |
|
D90011 |
Sparks Regional Medical Center |
|
D90012 |
Bridgeway |
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ARKANSAS COUNTIES
|
COUNTY NUMBER |
COUNTY NAME |
|
Oil |
ARKANSAS |
|
021 |
ASHLEY |
|
031 |
BAXTER |
|
041 |
BENTON |
|
051 |
BOONE |
|
061 |
BRADLEY |
|
071 |
CALHOUN |
|
081 |
CARROLL |
|
091 |
CHICOT |
|
101 |
CLARK |
|
111 |
CLAY |
|
121 |
CLEBURNE |
|
131 |
CLEVELAND |
|
141 |
COLUMBIA |
|
151 |
CONWAY |
|
161 |
CRAIGHEAD |
|
171 |
CRAWFORD |
|
181 |
CRITTENDEN |
|
191 |
CROSS |
|
201 |
DALLAS |
|
211 |
DESHA |
|
221 |
DREW |
|
231 |
FAULKNER |
|
241 |
FRANKLIN |
|
251 |
FULTON |
|
261 |
GARLAND |
|
271 |
GRANT |
|
281 |
GREENE |
|
291 |
HEMPSTEAD |
|
301 |
HOT SPRING |
|
311 |
HOWARD |
|
321 |
INDEPENDENCE |
|
331 |
IZARD |
|
341 |
JACKSON |
|
351 |
JEFFERSON |
|
361 |
JOHNSON |
|
371 |
LAFAYETTE |
|
381 |
LAWRENCE |
|
391 |
LEE |
|
401 |
LINCOLN |
|
411 |
LITTLE RIVER |
|
421 |
LOGAN |
|
431 |
LONOKE |
|
441 |
MADISON |
|
451 |
MARION |
|
461 |
MILLER |
|
471 |
MISSISSIPPI |
|
481 |
MONROE |
|
491 |
MONTGOMERY |
|
501 |
NEVADA |
|
511 |
NEWTON |
|
521 |
OUACHITA |
|
531 |
PERRY |
|
541 |
PHILLIPS |
|
551 |
PIKE |
|
561 |
POINSETT |
|
571 |
POLK |
|
581 |
POPE |
|
591 |
PRAIRIE |
|
601 |
PULASKI |
|
611 |
RANDOLPH |
|
621 |
SALINE |
|
631 |
SCOTT |
|
641 |
SEARCY |
|
651 |
SEBASTIAN |
|
661 |
SEVIER |
|
671 |
SHARP |
|
681 |
ST. FRANCIS |
|
691 |
STONE |
|
701 |
UNION |
|
711 |
VAN BUREN |
|
721 |
WASHINGTON |
|
731 |
WHITE |
|
741 |
WOODRUFF |
|
751 |
YELL |
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NOTE: There 1s no specific code for members of the Armed Forced who are on active duty, rather, specify and code the type of job which the person performs, e.g., clerk-typist (code 04)' or aircraft mechanic (Code 05).
from DHS.
NOTE: Applicant/client/recipient will be referred to as "client". Intake interviewer/caseworker will be referred to as "interviewer".
NOTE: For specific instructions, procedures and forms see DHS SSN * Procedures Manual.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.