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Initial assessment correspondance version 1.4
__ __ / __ __ / __ __ __ __
Application: Approved / Disapproved Details:______________________________________________________ ____________________________________________________________ Estimated Date of Admission: __ __ / __ __ / __ __ __ __ Details:______________________________________________________ ____________________________________________________________ ____________________________________________________________
Initial Assessment Correspondence Version 1.4 1
Full Name: ______________________________________________________________________
D.O.B: __ __ / __ __ / __ __ __ __ Age: ______________
Contact Details: (m)_____________________________(h)________________________________
Marital Status: Single Married De Facto Separated Divorced Casual Other Specify
Duration of Relationship: __________ months / years .
If the applicant is not married but currently in a relationship, are they prepared to put the relationship on hold whilst they participate in the program?
YES / NO
No. of Children: __________ Details: _________________________________________________
How did the Applicant find out about the Transformations Program: (Please tick)
Detox Facility Case Worker
Other (Please Specify
Initial Assessment Correspondence Version 1.4 2
Have you detoxed from illicit/licit drugs and alcohol for a minimum of 7 days?
Have you identified the problem that caused your life to become unmanageable.
Has the Applicant expressed a desire and is motivated to stop using and change their lifestyle.
Are you 18 years of age or older. (Applications from clients aged 16 to 18 years will be assessed on a range of issues including; guardianship; applicant maturity and current composition of Residents).
Have you ever been diagnosed with any mental health issues.
Are you able and prepared to pay in advance the Program Fee prior to
entering the Program: Youth Allowance: $400 + $50 Deposit = $450
Newstart: $450 + $50 Deposit = $500
Disability Support Pension (DSP) $620 + $50 Deposit = $670
Are you eligible for Centrelink payments.
Do you have any major outstanding loans or debts that may affect your ability to pay the Fortnightly Program Fee.
Do you agree to comply with Transformations Program Rules and requirements.
Are you in good physical health and able to fulfill the Work component of the Program.
Transformations is a holistic, faith based, Christian Program.
Are you accepting and willing to participate in the Spiritual Component of
Initial Assessment Correspondence Version 1.4 3
SUBSTANCE ABUSE HISTORY
Please provide the following details regarding your drug use.
Days Used Days Used
REHABILITATION & INTERVENTION HISTORY
Have you ever participated in a Rehabilitation or Intervention Program before: YES / NO
Type of Program
Initial Assessment Correspondence Version 1.4 4
Type of Program
12 Step (eg A.A, N.A)
Do you have any Pending Charges that are currently being dealt with:
YES / NO
(i.e Court dates & type of hearing etc.)
Are you currently on a Court Order or Parole? YES / NO
Initial Assessment Correspondence Version 1.4 5
If YES please provide: Type of Order:_________________ Conditions:______________________
Have you ever been diagnosed with any
mental health issues or illnesses?
(including depression & anxiety disorders)
Have you been diagnosed with any life
Do you have any scheduled surgeries
or need any operations in the next 12
Do you have any chronic medical
problems or illnesses that could hinder
your participation in any activity of the
Do you suffer from any of the following medical problems? YES / NO
If YES please provide details: (please select relevant medical problem and provide details)
List details of any other relevant Medical issues? (e.g details for hospital admission etc)
Initial Assessment Correspondence Version 1.4 6
Have you recently or previously been prescribed any medication? YES / NO
Prescribed Currently Duration of
Is there any additional information you should provide that may affect your Assessment?
Initial Assessment Correspondence Version 1.4 7
Initial Assessment Correspondence Version 1.4 8
CENTRO COCHRANE DO BRASIL ACUPUNTURA PARA SÍNDROME DO TÚNEL DO CARPO SÃO PAULO TÌTULO: ACUPUNTURA PARA SÍNDROME DO TÚNEL DO CARPO PERGUNTA A acupuntura é mais efetiva do que o placebo no tratamento da síndrome do túnel do carpo. Introdução: Os sinais e sintomas da compressão do nervo mediano no punho foram inicialmente denominados de neurite do mediano, neuropat
Dr Amal Beaini, Clinical Lead Dr Noufel Aljushaah, Medical Officer June 2011 • 1996: The first patient successfuly completed the compressed opiate detoxification programme. • 2000: Our peer reviewed paper gets published in • 2004: Extended services become available for those patients with concomitant addictions or underlying mental health problems. • 2006: Channel 4 series “