"Capacity Reporting Form - Bureau of Behavioral Health Wellness and Prevention" - Nevada

Capacity Reporting Form - Bureau of Behavioral Health Wellness and Prevention is a legal document that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada.

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  • Released on October 19, 2017;
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BUREAU OF BEHAVIORAL HEALTH WELLNESS AND PREVENTION
CAPACITY REPORTING FORM
Every BBHWP-funded program must report, within 1 day, to the BBHWP when they reach 90%
capacity or greater. Please fill out the following form and email it to BBHWP at
titled “90% Capacity Reporting – Agency Name”.
MOT_MM@health.nv.gov
Program Name______________________Person Filling out Report_________________________ _
As of __________(time of day) on ____________ (date of report), the following service levels have
reached 90% capacity.
A
B
C
D
Number of
Number of
Of those on the
Type of Interim Services Provided to Pregnant
Clients
Clients on
Waiting List
Women and IVDU Clients
LEVELS/TYPE OF SERVICE
Currently
Waiting
Number of
Served
List
Pregnant Women
and IVDU Clients
ASAM Level I Outpatient
Services
ASAM Level II Intensive
Outpatient/Partial Hospitalization
ASAM Level II.5 Partial
Hospitalization
ASAM Level III.1 Residential
BADA Level III.2 High Intensity
Residential.
ASAM Level III.3 Medium-
Intensity Residential Treat
ASAM Level III.5 Med/High-
Intensity Residential
ASAM Level III.2-D Clinically-
Managed Detoxification
ASAM Level III.7-D Medically-
Monitored Inpatient Detoxification
ASAM Opioid Maintenance
Therapy
Transitional Housing
Other
Other
titled “90% Capacity Reporting
Please email this information to the BBHWP at
MOT_MM@healht.nv.gov
– Agency Name” weekly until the service level falls below the 90% capacity rate. Thank-you for your
cooperation.
Revised 10/19/2017
BUREAU OF BEHAVIORAL HEALTH WELLNESS AND PREVENTION
CAPACITY REPORTING FORM
Every BBHWP-funded program must report, within 1 day, to the BBHWP when they reach 90%
capacity or greater. Please fill out the following form and email it to BBHWP at
titled “90% Capacity Reporting – Agency Name”.
MOT_MM@health.nv.gov
Program Name______________________Person Filling out Report_________________________ _
As of __________(time of day) on ____________ (date of report), the following service levels have
reached 90% capacity.
A
B
C
D
Number of
Number of
Of those on the
Type of Interim Services Provided to Pregnant
Clients
Clients on
Waiting List
Women and IVDU Clients
LEVELS/TYPE OF SERVICE
Currently
Waiting
Number of
Served
List
Pregnant Women
and IVDU Clients
ASAM Level I Outpatient
Services
ASAM Level II Intensive
Outpatient/Partial Hospitalization
ASAM Level II.5 Partial
Hospitalization
ASAM Level III.1 Residential
BADA Level III.2 High Intensity
Residential.
ASAM Level III.3 Medium-
Intensity Residential Treat
ASAM Level III.5 Med/High-
Intensity Residential
ASAM Level III.2-D Clinically-
Managed Detoxification
ASAM Level III.7-D Medically-
Monitored Inpatient Detoxification
ASAM Opioid Maintenance
Therapy
Transitional Housing
Other
Other
titled “90% Capacity Reporting
Please email this information to the BBHWP at
MOT_MM@healht.nv.gov
– Agency Name” weekly until the service level falls below the 90% capacity rate. Thank-you for your
cooperation.
Revised 10/19/2017