Divide one page into five headings: current risks, history, supports, practical constraints, and open clinical questions. Usethe core guide for California polysubstance rehab decisions to frame the substance-use details, then useLiving Longer Recovery admissions guidance for call preparation, fit, current availability, and next steps as a prompt to verify rather than assume.
Under current risks, record observable facts and timing. Note the substances involved, last known use, current symptoms, recent loss of consciousness or other urgent events, pregnancy if relevant, prescribed medications, major medical concerns, and whether the person can communicate clearly. Do not use this grid to decide whether withdrawal will be mild or severe. Ask a qualified professional what information changes the assessment and what should happen if symptoms worsen before an evaluation.
Under history, include prior treatment settings, previous withdrawal experiences, periods when substance use returned, medical or psychiatric care, and what helped or created barriers. Approximate dates are better than leaving the section blank. Under supports, list willing family members or trusted contacts, the person's current living situation, caregiving duties, and permission boundaries around family involvement. SAMHSA quality guidance supports asking how family may be involved, while recognizing that involvement should be appropriate to the person's circumstances and consent requirements. Such guidance does not prove that any particular facility provides a specific family service or schedule adjacent to it . Under practical constraints, note work, childcare, mobility, communication needs, court dates, travel limits, identification, and payment questions. These details should not<B
- Current risks: substances, timing, symptoms, medications, medical concerns, and immediate-danger questions
- History: prior settings, withdrawal experiences, returns to use, and barriers
- Supports: housing, trusted contacts, caregiving duties, and consent boundaries for family involvement skills varied with local shelters or communities with specialized support. 14-