In the medical field, there are many aspects that need to be considered before a physician can prescribe the best treatment for their patient. There is no one-size-fits-all approach when it comes to health care and diagnosis. In order to get the most accurate information about a certain ailment or disease, physicians will often turn to resources such as Asam Level Of Care Cheat Sheet in order to make an informed decision on what course of action they should take next with their patients. It's important for patients and doctors alike understand how different levels of care work so they know which level is appropriate for each situation. This way, both parties can set themselves up for success from day one.
Before you decide to fill in asam level of care cheat sheet, you will want to find out more concerning the type of form you are going to work with.
Question | Answer |
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Form Name | Asam Level Of Care Cheat Sheet |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | asam levels of care cheat sheet, asam criteria pdf 2020, asam worksheet, asam criteria cheat sheet 2019 |
Patient Placement Criteria Checklist - Kentucky Edition 2012
Based upon ASAM Adult Patient Placement
Client Name: ____________________________________ Date:_______________________ Case Number__________________
Directions: Rate the client or patient on each of the six Dimensions first and then analyze for Level of Care; emergency needs come first, then the least intensive LOC that is safe and can effectively help client reach goals.
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and Services |
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Level of Care I |
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Level of Care |
II.1 |
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Level of |
Care III.1 |
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Level of |
Care III.3 |
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Level of Care III.5 |
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Level of |
Care IV |
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OUTPATIENT |
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TRANSITIONAL |
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RECOVERY CENTER |
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INTENSIVE OUTPATIENT |
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RESIDENTIAL TREATMENT |
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INPATIENT HOSPITAL |
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(Less |
than 6 |
weekly |
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(including |
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(Staffed by peers and may include |
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Service Levels: |
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(6 to 20 service hours per week. |
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(Clinically managed. Includes licensed short |
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(Including medical |
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service |
hours. |
Includes |
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sober |
living |
facility with |
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credentialed or |
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Can be combined |
with |
housing |
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or long term |
rehabilitation |
unit, crisis |
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detoxification and |
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Medication Assisted |
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5+ |
hours |
of clinical |
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staff rather |
than clinically |
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and supports to be |
level |
III care.) |
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stabilization |
unit, licensed |
detox unit) |
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inpatient psychiatric units) |
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Treatments/MAT*) |
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services per week) |
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managed.) |
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Admission |
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Meets |
all Dimensions |
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Meets all |
Dimensions |
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Meets one of Dimensions |
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Meets Dimensions 1,2 & 3 at this |
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Meets all Dimensions below at this |
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Meets all Dimensions at this level plus |
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1, 2, or 3; plus meets |
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specifications |
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below |
at this |
level (if |
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below |
at this level; has |
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for each Level |
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not, consider |
a higher |
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level (if applicable), |
and one of |
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completed |
services for |
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level plus meets |
the criteria for a |
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meets criteria for a Substance Dependence |
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criteria for |
a Substance |
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Dimensions 4,5, or |
6 at this level |
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Substance Dependence Disorder |
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Disorder |
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Dependence |
Disorder or |
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of Care: |
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level of care) |
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acute symptoms |
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severe mental disorder |
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Dimension 1: |
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No withdrawal |
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If present, minimal risk of |
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If present, mild to moderate risk of |
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High risk of severe |
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Acute |
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needs OR needs can |
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No withdrawal needs OR |
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No signs or |
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severe withdrawal that can |
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severe withdrawal that can be |
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withdrawal which |
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Intoxication |
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be safely managed |
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needs can be safely |
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symptoms of |
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be managed at a social |
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managed at a social setting detox |
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cannot be managed |
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and/or |
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at this level, such as |
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managed at this level. |
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withdrawal |
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setting intake level with no |
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level with possible medication |
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in a |
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Withdrawal |
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with MAT. |
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medication support |
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support |
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detox |
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Potential |
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Dimension 2: |
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If present, stable OR |
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If present, stable and |
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If present, stable and can |
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If present, stable and can self- |
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Biomedical |
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no medical |
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administer meds OR severe enough |
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Severe enough to |
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None or sufficiently |
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receiving concurrent |
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Conditions |
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monitoring needed, |
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to obtain medical supports |
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to warrant medical monitoring but |
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warrant inpatient |
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stable |
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medical attention that will |
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and |
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OR can be monitored |
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from outside provider |
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not in need of inpatient treatment. |
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medical care |
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not interfere with treatment. |
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Complications |
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by outside provider. |
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May include pregnancy. |
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If present, mild to moderate severity |
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Dimension 3: |
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If present, stable, OR if |
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If present, mild to moderate |
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needing a |
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Severity of mental |
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If present, mild severity |
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severity: needs structure to |
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setting; repeated inability to control |
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Emotional, |
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distracting, can |
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disorder requires |
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None or very stable |
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responds to outpatient |
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focus on recovery. Could be |
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impulses; personality disorder |
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Behavioral or |
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respond to the level |
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medical monitoring, |
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(cognitively able to |
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monitoring to minimize |
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referred out to MH services. |
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requires high structure to shape |
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Cognitive |
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of |
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such as for danger to |
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participate and no |
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distractions from recovery; |
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If stable a DDC** program is |
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behavior. Needs |
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Conditions |
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in this program; can |
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self or others |
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risk of harm) |
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can receive concurrent |
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appropriate. If not a DDE*** |
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counseling/therapy. If stable a |
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and |
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receive concurrent |
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COD services. |
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program is required. |
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DDC** program is appropriate. If |
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Complications |
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COD services. |
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not a DDE*** program is required. |
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CLIENT NAME:________________________________________________ DATE: _____________________ CASE NUMBER:________________________ ____
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Level of Care I |
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Level of |
Care |
II.1 |
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Level of |
Care III.1 |
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Level of Care III.3 |
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Level of Care III.5 |
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Level of Care IV |
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OUTPATIENT |
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INTENSIVE OUTPATIENT |
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Transitional |
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RECOVERY CENTER |
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RESIDENTIAL TREATMENT |
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INPATIENT HOSPITAL |
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(Less |
than 6 |
weekly |
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(6 to |
20 service hours per |
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(including |
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(Staffed by peers and may include |
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(Clinically |
managed. Includes |
licensed short |
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(Including medical |
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Service Levels: |
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service |
hours. |
Includes |
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week. Can |
be combined |
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sober |
living |
facility with |
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credentialed or |
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or long |
term |
rehabilitation |
unit, crisis |
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detoxification and |
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Medication Assisted |
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with |
housing |
and |
supports |
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5+ |
hours |
of |
clinical |
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staff rather than clinically |
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stabilization |
unit, licensed |
detox unit) |
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inpatient psychiatric units) |
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Treatments/MAT*) |
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to |
be level III |
care.) |
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services per |
week) |
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managed.) |
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Ready to change and |
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Has marked difficulty with or |
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Willing to cooperate |
Resistance is high |
Has little awareness & needs |
opposition to treatment, with |
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cooperate at this |
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or is ambivalent and |
enough to require |
interventions available only |
dangerous consequences; or there |
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Dimension 4: |
level, OR externalizes |
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needs motivation, |
structured program, |
at this level to engage & stay |
is high severity in this dimension but |
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Readiness to |
problems and needs |
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recovery support, |
but not so high as to |
in recovery. May have |
not others. The client therefore |
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Change |
this level of structure, |
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and monitoring |
render outpatient |
external leverage to support |
needs a motivational enhancement |
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motivation and |
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strategies |
treatment ineffective. |
participation. |
program with 24 hour structure. |
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support. |
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Has little awareness & needs |
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Intensification of |
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Client is at high risk |
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intervention available only at |
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Has little awareness & needs |
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Able to maintain |
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for imminent relapse |
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this level to prevent |
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intervention available only at this |
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symptoms despite |
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Dimension 5: |
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abstinence and |
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with dangerous |
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continued use, with |
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level to prevent continued use, with |
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active participation in |
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Relapse, |
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recovery goals or |
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consequences. Client |
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dangerous consequences to |
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dangerous consequences to self or |
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Outpatient, OR high |
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Continued Use or |
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achieve awareness |
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needs |
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self or others. |
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others. |
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likelihood of relapse |
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Continued |
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of a substance use |
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structure and support |
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Does not recognize triggers, |
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Does not recognize triggers, unable |
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without close |
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Problem Potential |
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problem with minimal |
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OR needs this support |
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unable to control use, in |
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to control use, in danger of relapse |
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monitoring and |
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support |
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to transition into |
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danger of relapse without |
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without close |
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support |
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community. |
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close |
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and structure. |
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and structure. |
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Has a using, |
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Supportive recovery |
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Lacks social contacts |
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unsupportive, |
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Homelessness or lack of |
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environment OR |
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or social contacts |
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dangerous, or |
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Environment is dangerous or |
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Dimension 6: |
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safe, supportive recovery |
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willingness to obtain |
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aren’t conducive to |
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victimizing social |
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unsupportive of recovery and client |
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Recovery |
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environment and client |
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such OR supports |
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recovery, but with |
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network, or lacks a |
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lacks skills to cope outside of highly |
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Environment |
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needs |
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need professional |
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structure or support, |
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social network, |
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structured |
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learn to cope. |
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interventions. |
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the patient can cope |
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requiring this level of |
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*Medication Assisted Treatments (MAT) can occur at any level of care and includes methadone, buprenorphine, and medications to control cravings and withdrawal when other criteria are met for level of care. Methadone and Suboxone clinics are generally outpatient, but clients on MAT may sometimes need a higher level of care.
**DDC: Dual Diagnosis Capable Program - has a primary target population of individuals with substance related disorders but also has an expectation and willingness to treat individuals with
referral to concurrent mental health services.
***DDE: Dual Diagnosis Enhanced Program – the program has the combined capacity to treat both mental health and substance related disorders equally.
Rater’s Signature: ____________________________________________________________
Last revision: