Alcohol - Dictation Checklist

Alcohol - Dictation Checklist

Checklist for dictation of referrals to Alcohol services

Alcohol Services - Dictation Check list
  • Patient Demographics including CHI number
  • Patient Contact Number
  • Expectations of Referral
     - Information to patient only 
     - Reduce Alcohol Intake
    Support
     - Detox
     - Referral on to other agency 
     - Possible Admission
     - Damage Limitation
     - Relapse Prevention
     -
    Other (Please describe)
  •   What does the client want to do about drinking?  (e.g. has the client made a clear commitment to engage  treatment)
  • Duration and severity of alcohol problem  (recent blood results, withdrawal seizures/delirium tremens)
  • Risk factors (include information about history of aggression and lack of social support)
  • Comorbid psychiatric condition(s) (treatment and relevant medications prescribed, compliance with/response to treatment)
  • Involvement with other professionals/agency?
  • Are there any child protection issues? Yes/No