Level-of-Care Intake Documentation Checklist
A local checklist template for organizing level-of-care intake documentation, clinical review, and utilization-review handoffs.
Documentation template
Level-of-Care Intake Documentation Checklist
A practical intake documentation checklist for treatment centers that need clinical, utilization-review, and billing teams working from the same record.
Intake source context
- Referral source, payer, service request, and requested timing are visible.
- The team knows which payer, contract, state rule, or internal policy governs the review.
- Official ASAM source links are available for clinical and compliance owners.
Clinical documentation structure
- Current ASAM dimension terminology is available to the documentation owner.
- The note distinguishes observed facts from clinical conclusions.
- Medication, withdrawal, psychiatric, biomedical, and recovery-environment considerations are routed to the right owner.
- Person-centered barriers and preferences are captured for care planning.
Review and handoff
- Clinician review and signoff owner is clear.
- UR follow-up owner is assigned when payer authorization is needed.
- The next reassessment or transition review date is documented.
- Billing is held or released based on authorization status and documentation completeness.
Documentation items to review with your clinical or utilization-review owner
This template is a workflow aid only. It does not collect PHI, submit data, store selections, score the intake, recommend a level of care, assign a diagnosis, rate risk, decide placement, determine medical necessity, or make coverage conclusions.
Use official sources
ASAM's public pages describe Fourth Edition updates and implementation tools. Link clinical teams to official ASAM resources when source guidance is needed.
Related documentation resources
Common questions
Official sources
- ASAM Fourth Editionasam.org
- ASAM Assessment Guides landing pageasam.org