Chief Complaint/Problem statement
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Aftercare Plan Session Type
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Self-help support
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The amount of meetings you plan on attending per week?
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The amount of aftercare groups you plan on attending per week?
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Do you have a sponsor
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Name, location, and time of 3 meetings you could attend
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Spiritual, mental, intellectual, physical, emotional, social
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List recreational activities that pertain to your intellectual,emotional, physical, and spiritual wellbeing
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How many days per week do you plan on participating in these activies
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Do you have a primary doctor?
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Mental/Emotional
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Are you in need of further mental health treatment?
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If yes, please explain
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Financial
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Are you employed?
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Explain employment
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If not employed, how do you plan on financial supporting yourself?
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Social
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Are you living in a safe environment that supports recovery?
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Summary
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Date and Time
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Summary
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Completed By
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Client Signature
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