Survey-ready policies with the blanks marked

This policy establishes how PROGRAM NAME screens prospective clients, determines eligibility for admission, and completes the intake process in a consistent, documented and clinically sound manner. Its aim is that every person admitted is appropriate for the level of care offered, understands the services and conditions of treatment, and enters care with a complete, accurate record.

Fill in: [PROGRAM NAME], [STATE AGENCY], [CLINICAL DIRECTOR TITLE], [MEDICAL DIRECTOR TITLE], [INSERT CURRENT REQUIREMENT], [DIRECTOR TITLE], [APPROVING AUTHORITY], [EFFECTIVE DATE], [REVIEW DATE]

This policy sets the standards for content, accuracy, authentication, timeliness and correction of clinical documentation at PROGRAM NAME. Complete and timely records support safe care, continuity between staff, accurate billing and the program's ability to demonstrate compliance to STATE AGENCY, accrediting bodies and payers.

Fill in: [PROGRAM NAME], [STATE AGENCY], [CLINICAL DIRECTOR TITLE], [INSERT CURRENT REQUIREMENT], [REVIEW FREQUENCY], [QUALITY COMMITTEE], [COMPLIANCE OFFICER TITLE], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes how PROGRAM NAME plans and carries out discharges, transfers between levels of care, and continuing care arrangements. Its aim is that every transition is clinically appropriate, safe, coordinated and documented, and that each client leaves with a practical plan for sustaining recovery.

Fill in: [PROGRAM NAME], [CLINICAL DIRECTOR TITLE], [STATE AGENCY], [QUALITY COMMITTEE], [REVIEW FREQUENCY], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes how PROGRAM NAME determines the appropriate initial level of care for each client, reassesses that placement during treatment, and decides continued stay, transfer or discharge using The ASAM Criteria. Its aim is that every client receives services at the least restrictive level that is safe and clinically effective, and that each placement decision is supported by documented, dimension-by-dimension reasoning.

Fill in: [PROGRAM NAME], [STATE AGENCY], [CLINICAL DIRECTOR TITLE], [INSERT CURRENT REQUIREMENT], [MEDICAL DIRECTOR TITLE], [REVIEW FREQUENCY], [QUALITY COMMITTEE], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes the requirements for developing, implementing and updating an individualized treatment plan for every client of PROGRAM NAME. The plan is the working agreement between the client and the treatment team. It translates assessment findings into measurable goals, specific interventions and a clear path toward discharge and continuing care.

Fill in: [PROGRAM NAME], [STATE AGENCY], [INSERT CURRENT REQUIREMENT], [CLINICAL DIRECTOR TITLE], [REVIEW FREQUENCY], [DIRECTOR TITLE], [EFFECTIVE DATE], [REVIEW DATE]

This policy affirms the rights of every person served by PROGRAM NAME and establishes a fair, timely and retaliation-free process for clients to voice complaints and have them resolved. It is intended to protect dignity and autonomy, and to give the program reliable information for improving services.

Fill in: [PROGRAM NAME], [STATE AGENCY], [GRIEVANCE COORDINATOR TITLE], [DIRECTOR TITLE], [INSERT CURRENT REQUIREMENT], [APPEAL AUTHORITY TITLE], [QUALITY COMMITTEE], [REVIEW FREQUENCY], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes how PROGRAM NAME protects the confidentiality of client identifying information and substance use disorder treatment records, and the conditions under which that information may be used or disclosed. The program is a federally assisted substance use disorder program and a HIPAA covered entity, and it applies whichever federal or state rule provides the greater protection to the client in any given situation.

Fill in: [PROGRAM NAME], [PRIVACY OFFICER TITLE], [RECORDS CUSTODIAN TITLE], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes how PROGRAM NAME uses drug and alcohol testing as a clinical tool to support assessment, treatment planning, safety and recovery. Testing is therapeutic, not punitive. Results are used to guide care and are interpreted in the context of the client's history, medications and clinical presentation.

Fill in: [PROGRAM NAME], [MEDICAL DIRECTOR TITLE], [INSERT CURRENT REQUIREMENT], [REVIEW FREQUENCY], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes how PROGRAM NAME receives, stores, accounts for, assists with self-administration of, and destroys client medications in a program approved to provide incidental medical services. Its aim is safe, accurate and accountable medication handling that stays within the scope of the program's approval and each staff member's training and licensure.

Fill in: [PROGRAM NAME], [STATE AGENCY], [MEDICAL DIRECTOR TITLE], [INSERT CURRENT REQUIREMENT], [REVIEW FREQUENCY], [DIRECTOR TITLE], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes how PROGRAM NAME identifies, responds to, documents, reports and learns from incidents that affect the health, safety or rights of clients, staff and visitors. Its goals are immediate protection of those involved, timely notification of the state licensing agency and other required parties, and systematic review that prevents recurrence.

Fill in: [PROGRAM NAME], [STATE AGENCY], [STATE REPORTABLE EVENTS AND TIMEFRAMES], [DIRECTOR TITLE], [MEDICAL DIRECTOR TITLE], [INSERT CURRENT REQUIREMENT], [QUALITY COMMITTEE], [REVIEW FREQUENCY], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes how PROGRAM NAME monitors clients in residential and withdrawal management settings through scheduled safety rounds and individualized observation levels. Consistent, documented observation reduces the risk of overdose, medical deterioration, self-harm, unauthorized departure and other preventable harm.

Fill in: [PROGRAM NAME], [STATE AGENCY], [INSERT CURRENT REQUIREMENT], [DIRECTOR TITLE], [REVIEW FREQUENCY], [MEDICAL DIRECTOR TITLE], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes how PROGRAM NAME verifies that every workforce member is qualified for the role, is oriented before working independently, receives required ongoing training, and demonstrates competency in the tasks assigned. Qualified, competent staff are the foundation of safe care and regulatory compliance.

Fill in: [PROGRAM NAME], [STATE AGENCY], [INSERT CURRENT REQUIREMENT], [TRAINING COORDINATOR TITLE], [DIRECTOR TITLE], [REVIEW FREQUENCY], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes the conditions under which PROGRAM NAME delivers services by synchronous video, audio-only telephone and other approved telehealth modalities. Its aim is that telehealth services are clinically appropriate, safe, private, legally compliant and documented to the same standard as in-person services.

Fill in: [PROGRAM NAME], [STATE AGENCY], [PRIVACY OFFICER TITLE], [CLINICAL DIRECTOR TITLE], [REVIEW FREQUENCY], [EFFECTIVE DATE], [REVIEW DATE]

This policy establishes the utilization review (UR) process at PROGRAM NAME. Utilization review confirms that each client's admission, level of care and length of stay are supported by documented medical necessity, that services are used efficiently, and that the program communicates accurately and promptly with payers. It also protects clients from discharge driven by authorization status rather than clinical need.

Fill in: [PROGRAM NAME], [QUALITY COMMITTEE], [INSERT CURRENT REQUIREMENT], [REVIEW FREQUENCY], [CLINICAL DIRECTOR TITLE], [DIRECTOR TITLE], [EFFECTIVE DATE], [REVIEW DATE]