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Get Mental Health Discharge Summary Template 2007-2024

ASAIS ID: First Name: Last Name: Date of Birth: / / Co-Dependent/Collateral: Level of Care at Discharge: / Date of Last Contact: / Date of Discharge: MI: Yes No / / Reason for Discharge, Transfer or Discontinuance of Treatment Treatment Completed Left Against Professional Advice Terminated by Facility Transferred to Another Substance Abuse Treatment Program or Facility Transferred to Another Substance Abuse Treatment Program or Facility, but Did Not Report Incar.

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