Asam Blank Form PDF Details

What the ASAM Criteria Evaluates

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.

Who Uses This ASAM Assessment?

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.

QuestionAnswer
Form NameAsam Blank Form
Form Length12 pages
Fillable?No
Fillable fields0
Avg. time to fill out3 min
Other namesfull asam assessment form, asam criteria template, asam assessment template, asam assessment fill in form

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How to Complete the ASAM Criteria Assessment

  1. Open the form: Click the button on this page to access the ASAM criteria form online.
  2. Review each area: Read through all six ASAM criteria areas before completing the assessment.
  3. Fill in each area: Enter your clinical findings for each criteria area in the assessment fields.
  4. Determine care placement: Use your ratings to identify the care setting that fits the patient's needs.
  5. Download or print: Download a free copy of the completed assessment or print it from your browser.

Is This ASAM Form Available as a Fillable Document?

You can open this ASAM criteria assessment and complete it using FormsPal's free online tool. The tool lets you type directly into the fields, add annotations, and download your completed copy. This makes it easy to produce a print-ready assessment without extra software.

What Version of the ASAM Criteria Does This Form Use?

This assessment is based on the ASAM criteria fourth edition, the most widely adopted version in clinical practice today. The fourth edition improved how co-occurring disorders and environmental factors are evaluated. Quality programs across the country rely on it as the standard for substance use assessment.

Where Can I Find Related Assessment Forms?

FormsPal has several related forms for behavioral health providers. The addiction severity form provides a broader evaluation of substance use impact. For mental health billing, the mental health superbill offers a standardized billing template for clinical practice.

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