Form NDP20N "Substance Dependence/Abuse" - Alabama

What Is Form NDP20N?

This is a legal form that was released by the Alabama Department of Mental Health - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Alabama Department of Mental Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form NDP20N by clicking the link below or browse more documents and templates provided by the Alabama Department of Mental Health.

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Download Form NDP20N "Substance Dependence/Abuse" - Alabama

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NDP 20n
July 2018
NAME __________________________________________________
Substance Dependence/Abuse
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
Related To:
□ No withdrawal
(Address all items listed
NURSING
in “goal/outcome”
□ Current
symptoms
1. Assess psych
column. If goal not met,
Diagnosis
□ No drug use
functioning, including
revise plan)
__________ (state)
□ Balance
SI/HI _______
□ Hx of Inpatient
nutritional intake
(state frequency)
treatment (date of
daily
2. Assess Review of
last admission)
□ No harm to self
Systems(frequency)
_________
or others
________
□ Family Hx
□ Performs ADLs
3. Assess for
□ Hx Drug Abuse
daily
signs/symptoms of
(drug of choice
□ Takes meds as
withdrawal
__________)
ordered QD
4. Facilitate
□ Mental Illness
□ VS WNL QD
attendance/
□ Peer Pressure
□ Verbalizes
participation in
□ Low self-esteem
adaptive coping
support group(s)
□ Emotional
methods
5. Other (state)
distress
□ Other (list)
□ Other (list)
DELEGATE
1. Meds as ordered
AEB:
2. VS QD
□ Physical
3. Encourage ADLs
Dependence/
4. Monitor I & O
Withdrawal
5. Monitor for:
□ Psychological
seizures
Dependence
lack of ADLs
□ Legal Problems
SI/HI
□ Impaired
6. Encourage balanced
work/social/family
intake
functioning
7. Weigh __________
Substance Dependence/Abuse
NDP 20n
July 2018
NAME __________________________________________________
Substance Dependence/Abuse
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
Related To:
□ No withdrawal
(Address all items listed
NURSING
in “goal/outcome”
□ Current
symptoms
1. Assess psych
column. If goal not met,
Diagnosis
□ No drug use
functioning, including
revise plan)
__________ (state)
□ Balance
SI/HI _______
□ Hx of Inpatient
nutritional intake
(state frequency)
treatment (date of
daily
2. Assess Review of
last admission)
□ No harm to self
Systems(frequency)
_________
or others
________
□ Family Hx
□ Performs ADLs
3. Assess for
□ Hx Drug Abuse
daily
signs/symptoms of
(drug of choice
□ Takes meds as
withdrawal
__________)
ordered QD
4. Facilitate
□ Mental Illness
□ VS WNL QD
attendance/
□ Peer Pressure
□ Verbalizes
participation in
□ Low self-esteem
adaptive coping
support group(s)
□ Emotional
methods
5. Other (state)
distress
□ Other (list)
□ Other (list)
DELEGATE
1. Meds as ordered
AEB:
2. VS QD
□ Physical
3. Encourage ADLs
Dependence/
4. Monitor I & O
Withdrawal
5. Monitor for:
□ Psychological
seizures
Dependence
lack of ADLs
□ Legal Problems
SI/HI
□ Impaired
6. Encourage balanced
work/social/family
intake
functioning
7. Weigh __________
Substance Dependence/Abuse
NDP 20n
July 2018
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
□ Financial
(frequency)
Problems
□ Medical
8. Other (list)
Problems
(specify)
□ SI/HI
□ Other (list)
RN SIGNATURE:
DATE:
Substance Dependence/Abuse
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