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Patient Placement Criteria Checklist Kentucky Edition 2012 Based upon ADAM Adult Patient Placement CriteriaSecond Edition Revised Client Name: Date: Case Number Directions: Rate the client or patient
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How to fill out the ASAM criteria cheat sheet:

01
Familiarize yourself with the ASAM criteria guidelines and requirements.
02
Obtain a copy of the ASAM criteria cheat sheet.
03
Review each section of the cheat sheet and understand the corresponding criteria.
04
Assess the individual or program being evaluated against each criterion on the cheat sheet.
05
Provide relevant information and evidence for each criterion, ensuring accuracy and specificity.
06
Use clear and concise language when filling out the cheat sheet to accurately reflect the individual or program's qualifications.
07
Double-check your responses for completeness and accuracy before submitting the cheat sheet.

Who needs the ASAM criteria cheat sheet?

01
Individuals or organizations responsible for evaluating substance abuse programs.
02
Treatment providers and clinicians assessing patients for appropriate intervention levels.
03
Program administrators ensuring compliance with ASAM criteria for optimal service delivery.
04
Regulatory bodies or accrediting agencies verifying the adherence of programs to the ASAM criteria.
05
Researchers or evaluators collecting data on the effectiveness of treatment programs according to ASAM standards.

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ASAM CONTINUUM is an electronic assessment tool that allows clinicians, counselors, and other staff to leverage a computerized clinical decision support system (CDSS) to assess individuals with addictive substance use disorders and co-occurring conditions.
Dimension 5: Relapse, Continued Use or Continued Problem Potential. Is the patient in immediate danger of continued severe mental health distress and/or alcohol or drug use?
For example, significant problems with readiness to change (Dimension 4), coupled with a poor recovery environment (Dimension 6) or moderate problems with relapse or continued use (Dimension 5), may increase the risk of relapse.
0 – no or very low risk. Stable. 1 – mild discomfort, can be stabilized, functioning. 2 – moderate risk/difficulty functioning but can. 3 – serious difficulties – in or near imminent danger. 4 – highest concern – severe, persistent, poor ability.
The fourth dimension explores an individual's readiness and interest in changing. Leaning on the transtheoretical model of behavior change (TTM), this dimension helps clinicians develop individualized care for people based on their readiness to change.
Dimension 1 – Acute intoxication and/or withdrawal. Dimension 2 – Biomedical conditions and complications. Dimension 3 – Emotional, behavioural, or cognitive conditions and complications. Dimension 4 – Readiness to change.

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The ASAM Dimensions Cheat Sheet is a tool that helps healthcare providers assess a patient's level of care needs based on the ASAM Criteria. It provides guidance on evaluating dimensions such as the patient's substance use history, severity of addiction, and psychosocial factors.
Healthcare providers, particularly those involved in addiction treatment and mental health services, are required to use and file the ASAM Dimensions Cheat Sheet as part of the assessment and treatment planning process for patients with substance use disorders.
To fill out the ASAM Dimensions Cheat Sheet, providers must gather comprehensive information from the patient regarding their clinical history, current substance use, psychosocial history, and any other relevant factors that influence their treatment needs. The provider then uses this information to complete each dimension on the cheat sheet.
The purpose of the ASAM Dimensions Cheat Sheet is to standardize the assessment process for individuals with substance use disorders, ensuring that all relevant factors are considered when determining the appropriate level of care and treatment options.
The information that must be reported on the ASAM Dimensions Cheat Sheet includes the patient's substance use patterns, mental health status, physical health conditions, social support systems, and other dimension-specific factors that influence treatment decisions.
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