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PURPOSE FOR ASAM
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History of Withdrawal DIM 1
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Initial Risk Rating Dimension 1
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Dimension 1 Severity summary
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Dimension 2: Biomedical Conditions and Complications
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Initial Risk Rating Dimension 2
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Dimension 2 Severity summary
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Dimension 3: Emotional/Behavioral/Cognitive Conditions
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Initial Risk Rating Dimension 3
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Dimension 3 severity summary
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Dimension 4 Readiness to Change
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Dimension 4 severity explanation
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Initial Risk Rating Dimension 4
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Dimension 5: Relapse Potential
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Initial Risk Rating Dimension 5
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Severity summary Dimension 5
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Dimension 6: Recovery Living Environment
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Initial Risk Rating Dimension 6
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Severity summary Dimension 6
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OVERALL ASSESSMENT OF THE DIMENSIONS
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OVERALL ASSESSMENT OF THE DIMENSIONS
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signed by pin#
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signed by pin#
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