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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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The ASAM Criteria Cheat Sheet is a quick reference guide to the American Society of Addiction Medicine (ASAM) criteria, which is used to classify the severity of a patient's addiction. It provides a list of criteria used to assess the severity of an addiction and to determine the level of care and treatment needed. The cheat sheet also contains definitions of terms used in the ASAM criteria and examples of how the criteria can be applied to patients.
Everyone who is required to meet the criteria of the American Society of Addiction Medicine (ASAM) Criteria must file the cheat sheet.
1. Begin by writing the name of the assessment tool (ASAM Criteria) at the top of the sheet. 2. In the first column, list the six ASAM criteria dimensions. 3. In the second column, write down the criteria for each dimension. 4. In the third column, list the questions you will use to assess each criterion. 5. In the fourth column, write down the answers to the questions. 6. In the fifth column, rate the client’s answer to each question on a scale of 1-5, with 1 being the least severe and 5 being the most severe. 7. In the sixth column, add up the ratings for each dimension to get a total score. 8. Finally, review the total scores and compare them to the criteria to determine the level of care needed.
The ASAM Criteria Cheat Sheet is a quick reference guide for clinicians and organizations using The ASAM Criteria, a set of evidence-based clinical criteria used to assess and treat individuals with substance use disorders. The Cheat Sheet is designed to help clinicians quickly identify which of the six dimensions of the criteria they need to assess and which corresponding criteria they need to consider in their assessment. It also provides clinicians with guidance on how to interpret the criteria and provides references to helpful resources.
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