Outpatient Substance Abuse Rehabilitation Treatment Plan Form

Form Template

The Outpatient Substance Abuse Rehabilitation Treatment Plan Form standardizes the submission of a treatment plan to insurance providers.

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The form details Member and Provider Information, a Diagnosis, along with DSM codes for mental health treatment, existing drug abuse and alcohol abuse history, treatment history, support systems in place, a treatment plan, and the patient's responses to treatment in the past, including inpatient treatment, outpatient drug rehab, other types of drug rehab, mental health treatment, and medication based treatment. Any treatment program or treatment center seeking reimbursement from insurance providers could benefit from this form when engaging in intensive outpatient programs.

This form is best utilized in outpatient programs for drug rehab and drug addiction. Treatment centers that specialize is drug abuse and alcohol abuse can submit mental health diagnoses to insurance companies in order to seek reimbursement for a treatment center's outpatient program, or any other intensive outpatient program including residential treatment, rehab treatment, drug treatment, alcohol rehab, group therapy, and other substance abuse treatment programs with a focus on outpatient care.

  • Signature Capture
  • Conditional Fields
  • Submission Editing
  • Reference Data
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