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Dhs 5204 eng form-2026

The document is a fillable PDF form for the Rule 25 Assessment by the Alcohol and Drug Abuse Division, designed to evaluate individuals for substance use disorders. It includes instructions for saving and completing the form, confidentiality notices, and various sections to gather personal information, medical history, substance use patterns, emotional and behavioral conditions, readiness for change, relapse potential, and recovery environment. The assessment aims to determine the severity of substance use issues and recommend appropriate treatment options.

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Click ‘Get Form’ to open the DHS 5204 ENG form in the editor.
Begin by filling out the 'Background Information' section. Enter the date of assessment request, assessment date, assessor details, and client information such as name, date of birth, and contact numbers.
Proceed to 'Dimension I – Acute Intoxication/Withdrawal Potential'. Here, provide details about chemical use history and withdrawal symptoms. Use the text fields to describe patterns of use and any relevant medical history.
Continue through each dimension of the form, ensuring you answer all questions thoroughly. Utilize our platform's features to save your progress frequently.
Once completed, review all entries for accuracy. Save a copy of your filled form on your computer for future reference.

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