Transitional Housing Unit Admission/Discharge Form (rev. 01/13/2015)

 Client #:                          Client Name: 

⇒ Selected Client – Profile of Client – Client Tab – Select DADS THU for Type 105; Treatment for Phase and Save
Selected Client – Profile of Client – Plan of Care Tab – New Document, to create Treatment Plan - Name Treatment plan as your THU – Episode Admit Reason is 103: Treatment or 118: THU – New Document to add Bed Days as Planned Services.
Client Information – Financial – Employment – Employment Tab
 *Employment Type: 
100 = Full Time, > 35 hours
119 = Not in labor force/Unempl. Not seeking 
107 = Student, FT
106 = Employed Student /part time
101 = Part Time, < 35 hours
103 = Homemaker seeking empl.
108 = Student, PT
105 = Disabled and unempl/not seeking
116 = Unemployed, seeking past 30
104 = Home maker not seeking employment
   

 Yearly Earnings: 

Remember to Associate Employment Information.
 Client Companies – Your Company – Episodes – Current Episode – Cost Center Locations – Cost Center – Profile of Cost Center Location - Admission Tab
 
 * Admit Date:               Staff Name: 
 * Admission Reason:      Substance Abuser
 
 * Referral Type: 
111: SACPA
119: School/College
130: State Drug Court Partnership (DCP)
112: Self
120: Medical
131: Comprehensive Drug Court Implementation (CDCI)
113: Twelve Step Program
121: Community Services
132: Dependency Court/Child Protective Services
114: Social Services
124: Public Health
136: DWC
115: Federal/State Criminal Justice
125: Residential Care Facility
137: AB109 Post-Release Community Supervision
116: Local/County Criminal Justice
127: Brochure/Flyer/Newspaper
203: DA Drug/Alcohol Program
117: Family/Friend
128: Telephone/Directory
998: Other
118: Employer
129: DUI/DWI
255: Youth System of Care (YSOC)
500: Transitional Age Youth (TAY)    
 Note: If SACPA, must enter SACPA – Parole or Probation even if a program transfer 
Client Companies – Your Company – Episodes – Current Episode – Cost Center Locations – Cost Center – Profile of Cost Center Location – Cost Center 
 
Cost Center Identifiers:
 111: CWHA AOD Only
 235: DFCS (Division of FCS)
 430: Homeless Grant
 480: AB109 Measure A
 155: DCP Grant
 260: AB109- CJ Realignment
 450: DWC
 490: Parolee
 175: ASOC
 265: AB109- CASU
 460: AB109-180 day
 500: Transitional Age Youth (TAY)
 190: CDCI
 255: Youth System of Care (YSOC)
 470: SAMHSA DD
 
 
DISCHARGE INFORMATION
Client Information – Financial – Employment – Right Click, New Employment Tab (Note: Update if changed from admission)
*Employment Type: 

100 = Full Time, > 35 hours

119 = Not in labor force/Unempl. Not seeking

107 = Student, FT

106 = Employed Student /part time

101 = Part Time, < 35 hours

103 = Homemaker seeking empl.

108 = Student, PT

105 = Disabled and unempl/not seeking

116 = Unemployed, seeking past 30

104 = Home maker not seeking employment

   
 
* Discharge Date:                    Staff Name: 
* Discharge Reason: 

101: Completed treatment plan/goals

107: Terminated by clinic: record open, no treatment provided

102: Left before completion with satisfactory progress

108: Terminated by clinic: incarcerated

103: Left before completion with unsatisfactory progress

109: Referred or transferred for further substance abuse treatment

104. Terminated by clinic: fee non-compliance

110: Moved

105: Terminated by clinic: non-compliance with treatment plan

111: Death

106: Terminated by clinic: other administrative factors

 
*  Input Required      
California Welfare and Institution Code Section 5328 and Title 24, Code of Federal Regulations Part 2, Confidential Client Information