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Group Type
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Module
• • •
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Group Topic
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MODIFIER
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HO
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U6
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U4
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Group Description
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Time Start
• • •
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Time End
• • •
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On time
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Facilitator(s)
• • •
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Additional facilitator(s)
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INDIVIDUAL ASSESSMENTS
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Mental Status WNL
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Judgment
• • •
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Insight
• • •
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Affect
• • •
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Mood
• • •
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Attitude/Cooperation/Motivation:
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Identification
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Identification of coping skills
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Client participation
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impacts of substance abuse
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Peer interaction
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Reflection
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Additional mental status comments
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Therapist/peers comments:
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Therapist/peers comments:
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ELECTRONIC SIGNED FIELD
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Electronic Signature by
• • •
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!DO NOT USE!
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