2333.1 To determine eligibility for substance abuse treatment, and to ensure compliance with §2332.1, an addiction counselor or trained paraprofessional shall collect intake/screening information from the individual as follows:

1. (a) Demographic information including but not limited to photo ID, primary language, name, age, address, living arrangements, social security number, race/ethnicity, source of referral, sex and sexual orientation, marital status, religion, education/training, employment status, emergency contact, military status, disability status, type of health insurance, and criminal justice involvement;
2. (b) The presenting problem including a statement of the circumstances or symptoms prompting the individual to seek services at this time;
3. (c) Existing personal support systems;
4. (d) Self-reported history of prior medical hospitalizations, substance abuse and psychiatric treatment episodes;
5. (e) Self-reported history of chronic medical problems affecting daily life, name and telephone number of primary care physician, and voluntary reporting of the status of HIV testing and results;
6. (f) Report of alcohol and/or drug consumption and quantity, type of drug, route of administration, and frequency in last 30 days;
7. (g) Record of prior treatment for emotional problems and current mental health status as observed and self-reported, particularly as it relates to current level of danger to self or others; and
8. (h) Diagnostic summary of interviewer's impressions and observations.

SOURCE: Final Rulemaking published at 47 DCR 9341 (November 24, 2000), adopting Emergency and Proposed Rulemaking published at 47 DCR 7708, 7754 (September 22, 2000).