This form follows the ASAM criteria standard for evaluating substance use disorders. The criteria define six areas, each scored to reflect the patient's current needs:
Ratings across all six areas guide the care placement decision. Care options range from early intervention at 0.5 to intensive inpatient treatment at Level 4. A patient with high acute risk and limited recovery support may require residential placement.
Professionals trained in addiction medicine, behavioral health, and mental health services use this form during intake and reassessment. These include addiction counselors, clinical social workers, licensed professional counselors, and psychiatrists.
Treatment programs, hospitals, and outpatient clinics use ASAM criteria to maintain quality documentation and consistent assessments. Reassessments track patient progress and help adjust the care setting over time. You can review the ASAM level of care cheat sheet for a quick comparison of care options. The Addiction Severity Index measures substance use severity. For drug testing documentation, see the drug testing consent form.
| Question | Answer |
|---|---|
| Form Name | Asam Blank Form |
| Form Length | 12 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 3 min |
| Other names | full asam assessment form, asam criteria template, asam assessment template, asam assessment fill in form |