Template library · Assessments & screeners
Substance Use Component template
Assess substance use history and current use patterns.
Substance use history supplement to biopsychosocial intake
- 21 fields across 4 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Substances Used (Lifetime)
- AlcoholTick box
- CannabisTick box
- OpioidsTick box
- StimulantsTick box
- Sedatives / benzodiazepinesTick box
- Nicotine / tobaccoTick box
- OtherTick box
Use Patterns
- Frequency and quantity of current useText
- Age of first useText
- Prior treatment episodesText
- Withdrawal historyText
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
- Client SignatureSignature
- Date signed (client)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
Spend less time on admin, more time with clients
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