[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-357985-105":3,"doc-detail-357985-en":81,"detail-sidebar-cat-1-en-105":99},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","recovery-residences-101-forms-package","Recovery Residences 101 Forms Package","","Recovery Residences 101 Forms Package provides pre-entry and resident entry templates for collecting admission, demographic, legal, supervision, and treatment-related information. It includes a pre-entry screen covering referral source, diagnosis, substance use history, self-harm risk, medication details, legal mandates, drug screen discussion, and interview logistics. The resident entry form captures personal contact data, emergency contacts, probation/parole status, warrants, education, employment, household income, religious preference, and military service, plus space for additional notes and office-use resident ID and move-in date.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/recovery-residences-101-forms-package/357985/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/recovery-residences-101-forms-package/357985.png","ImageObject",442,249,{"name":42,"@type":43},"Dipper","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-16","2026-09-23",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What information is collected in the pre-entry screen?","Question",{"text":63,"@type":64},"The pre-entry screen collects referral source, entry date, diagnosis, prior treatments, recovery history, medications, self-harm history, relationship and children details, drug use preferences, legal issues, warrants, and whether drug screens and fees have been discussed.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What does the resident entry form record about resident identity and contact details?",{"text":68,"@type":64},"It records resident name, address, city/state/ZIP, phone numbers, email, date of birth, age, marital status, children and their names/ages, spouse/partner information, and emergency contact information including release-of-information status.",{"name":70,"@type":61,"acceptedAnswer":71},"Which legal and supervision details are included in the forms?",{"text":72,"@type":64},"The forms ask whether the resident is legally mandated, includes legal charges, probation/parole status, outstanding warrants, prior convictions for violent or sexual crimes, and supervision officer contact details, plus whether progress will be reported to the probation officer.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},357985,1791238725,{"code":4,"msg":82,"data":83},"success",{"doc_id":79,"user_id":84,"nickname":42,"user_avatar":85,"doc_module":22,"category_id":86,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":87,"file_id":88,"file_url":89,"file_type":90,"file_size":91,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":92,"language":93,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":94,"faqs":95,"seo_title":96,"seo_description":12,"update_tm":97,"read_time":98},1374404997633,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd",17,"Recovery Residences 101 Forms Template  \nYOUR Recovery Residences [www.yourwebsite.com](www.yourwebsite.com)  \n (000) 123-4567 office   \nPre-Entry Screen  \nStaff Member:   Date of Screen:   Name:  Age:   Gender: M F T  \nReferral Source:  Entry Date:  Co-occurring Diagnosis  Prior Treatment(s):  Recovery Residence History  Drug(s) of Choice: Any IV Opiate Use: Y N   Recovery Time:  Medications:  History of Self-Harm:  Recent Suicidal ideation Homicidal ideation:   Relationship Status:   Children:   Sexual Orientation:  Work Experience/Plan:   Parent/Family Support:   Location:  TB Test Y N (Must bring or have copy of results) Fees Discussed: Y N $ /mo.  \nEver been arrested, convicted, or questioned for any violent or sexual crimes: Y N  \nAny outstanding warrants: Y N   Legal Issues:  Are you legally mandated to be here? Y N Legal Charge?   Vehicle: Y N Valid License: Y N Drug Screens Discussed: Y N  \nLocation Preference:  Interview D/T/C:   \nPLEASE WRITE ANY ADDITIONAL NOTES ON THE BACK OF THIS FORM.  \nFOR OFFICE USE ONLY Resident ID:    \nMove‐in Date:   /  /    \nRESIDENT ENTRY INFORMATION  \nPlease answer the following questions below.  \n1. What is your gender?  \n□ Male  \n□ Female  \n□ Transgender  \n2. How old are you?  \n___ ___ (age)  \n3. Are you Hispanic or Latino?  \n□ Yes  \n□ No  \n4. What is your race (chose one; if multiple, chose “Other” and describe)?  \n□ White/Caucasian  \n□ Black/African American  \n□ Asian (includes Native Hawaiian or other Pacific Islander)  \n□ Native American (includes Alaska Native)  \n□ Other:    \n5. Who suggested that you come here (chose one option that best applies)?  \n□ Family/Friend  \n□ Employer/Coworker  \n□ Treatment or human services professional  \n□ Representative of the courts/judicial system  \n□ No one  \n□ Other:    \n6. How long have you been drug and alcohol free?  \n□ Less than a month → How many days?    \n□ One to three months  \n□ Four to six months  \n□ Seven months to a year  \n□ More than one year  \n7. In the past 30 days, where have you been living most of the time (chose one option that best applies)?  \n□ My own home/apartment  \n□ Someone else’s home/apartment  \n□ In a medical, treatment, or other residential recovery setting  \n□ In jail, prison, or another correctional setting  \n□ In a shelter or another temporary housing facility  \n□ Outdoors or on the streets  \n□ Other:    \n8. What is the highest level of education you have finished, whether or not you received a degree?  \n□ Elementary/Junior high/middle school/some high school:   (grade)  \n□ High school graduate/GED  \n□ Vocational degree  \n□ Some college:   (number of years)  \n□ College graduate:  (degree; e.g. , AA, BA, MA, etc)  \n9. Are you currently enrolled in school or a job training program?  \n□ Not enrolled  \n□ Enrolled full-time  \n□ Enrolled part-time  \n□ Other:   10. Are you currently employed (chose one option that best applies)?  \n□ Employed full-time (35+ hours per week)  \n□ Employed part-time  \n□ Unemployed and looking for work  \n□ Unemployed and not looking for work (e.g. , retired, disabled, enrolled in school, etc)  \n□ Other:   11. Are you currently awaiting charges, trial, or sentencing?  \n□ Yes  \n□ No  \n□ Don’t know  \n12. Are you currently on parole or probation?  \n□ Yes  \n□ No  \n□ Don’t know  \n13. In the past 30 days, did you attend any self-help or recovery support groups?  \n□ Yes → If yes, how many?    \n□ No  \n14. How would you rate your quality of life?  \n□ Very poor  \n□ Poor  \n□ Neither poor nor good  \n□ Good  \n□ Very good  \n15. What would you like to accomplish during your stay here?  \n____________________________________________________________________________________  \n____________________________________________________________________________________  \n____________________________________________________________________________________  \n____________________________________________________________________________________  \n____________________________________________________________________________________","cbCaivKBEFIw4LMr","https://ap.wps.com/l/cbCaivKBEFIw4LMr","pdf",351889,32,"English","# Pre-Entry Screen\n## Resident Entry Information\n## Resident Information\n## Demographic Information","[{\"question\":\"What information is collected in the pre-entry screen?\",\"answer\":\"The pre-entry screen collects referral source, entry date, diagnosis, prior treatments, recovery history, medications, self-harm history, relationship and children details, drug use preferences, legal issues, warrants, and whether drug screens and fees have been discussed.\"},{\"question\":\"What does the resident entry form record about resident identity and contact details?\",\"answer\":\"It records resident name, address, city/state/ZIP, phone numbers, email, date of birth, age, marital status, children and their names/ages, spouse/partner information, and emergency contact information including release-of-information status.\"},{\"question\":\"Which legal and supervision details are included in the forms?\",\"answer\":\"The forms ask whether the resident is legally mandated, includes legal charges, probation/parole status, outstanding warrants, prior convictions for violent or sexual crimes, and supervision officer contact details, plus whether progress will be reported to the probation officer.\"}]","Recovery Residences 101 Forms Package | PDF",1790132439,11,{"code":4,"msg":82,"data":100},[101,105,110,115,120,125,128,133,138],{"id":98,"doc_module":22,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},"Presentations",90,"presentations",{"id":106,"doc_module":22,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},12,"Resumes",80,"resumes",{"id":111,"doc_module":22,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},14,"Invoices",70,"invoices",{"id":116,"doc_module":22,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},15,"Posters",60,"posters",{"id":121,"doc_module":22,"doc_module_name":25,"category_name":122,"show_sort_weight":123,"slug":124},16,"Social Media",50,"social-media",{"id":86,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":126,"slug":127},40,"forms",{"id":129,"doc_module":22,"doc_module_name":25,"category_name":130,"show_sort_weight":131,"slug":132},18,"Letters",30,"letters",{"id":134,"doc_module":22,"doc_module_name":25,"category_name":135,"show_sort_weight":136,"slug":137},21,"Paper Templates",5,"papers-templates",{"id":139,"doc_module":22,"doc_module_name":25,"category_name":140,"show_sort_weight":4,"slug":141},158,"General","general-158"]