ASI Self-Report Form - Center for Health Care Evaluation - chce research va 2026

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The document is an ASI Self-Report Form designed to collect information about an individual's background, employment, health, family relationships, alcohol and drug use, and legal situation. It includes a series of questions that require respondents to provide personal details and assess their experiences over the past 30 days regarding various issues such as medical problems, emotional distress, substance use, and legal challenges.

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Click ‘Get Form’ to open the ASI Self-Report Form in the editor.
Begin with Part I: Your Background and Employment. Fill in your birth date, marital status, and answer questions regarding your employment history by placing an 'X' in the appropriate boxes or writing in the required information.
Move to Part II: Your Health. Record any medical problems experienced in the past 30 days and indicate how these have affected you. Be sure to answer all questions about psychological issues honestly.
Proceed to Part III: Your Family Relationships. Reflect on any conflicts with family members and indicate how these have impacted you emotionally.
In Part IV: Your Alcohol and Drug Use, document your usage patterns over the past month, including frequency and any related problems.
Finally, complete Part V: Your Legal Situation by answering questions about any legal issues you may be facing.

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What is an ASI test?

The ASI covers seven (7) important areas of a patients life: medical, employment / support, drug and alcohol use, legal, family / social, and psychiatric. The instrument is designed to obtain lifetime information about problem behaviors as well as focusing specifically on the 30 days prior to assessment.

What is an ASI assessment?

Addiction Severity Index (ASI) Purpose: The ASI is most useful as a general intake screening tool. It effectively assesses a clients status in several areas, and the composite score measures how a clients need for treatment changes over time.

What are the 7 domains of ASI?

The Addiction Severity Index (ASI) was introduced in the United States in 1980 as a comprehensive instrument designed to assess the impairments that commonly occur in individuals with substance use disorders (SUDs) (McLellan, Luborsky, Woody, OBrien, 1980).

What is the ASI test?

Addiction Severity Index (ASI) is defined as an assessment tool used in evaluating substance abuse treatment, which involves an interview process to assess the history, frequency, and consequences of alcohol and drug use, along with other relevant indicators.

What is the ASI in court?

Addiction Severity Index (ASI) The ASI is a treatment assessment instrument.

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What is the purpose of the ASI?

Addiction Severity Index (ASI) It effectively assesses a clients status in several areas, and the composite score measures how a clients need for treatment changes over time.

ASI Self-Report Form - Center for Health Care Evaluation - chce research va 2026

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What is an ASI test?

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