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Location
• • •
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Miscellaneous Info
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Wellbeing Scale
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Stress scale 1-10
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Triggers and Cravings Scale 1-10
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Social Wellbeing Scale 1-10
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Overall Wellbeing scale 1-10
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Individual Note
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Focus of Session
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Comments
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Observations
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Observation Comments:
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Patient Response
• • •
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Insight
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Motivation
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Comments
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Goals
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Goals Addressed
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Concerns/Progress
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Peer Support/Concern for provider
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Signature Line
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Signature
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Switch on if prescriptions appear on note
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