An addiction assessment template structures an intake or follow-up around substance use, withdrawal risk, level-of-care criteria, and safety, the details that decide where and how a patient gets treated.
Head of Growth and Operations, JotPsych
Addiction medicine visits move fast and carry high stakes: a missed withdrawal symptom or an unasked question about lethal means can change what happens to a patient that day. A structured template keeps the visit organized around what the clinician needs to decide, not just what gets said. It fits addiction intakes and follow-ups, medication-assisted treatment visits, and any primary care or integrated behavioral health visit where substance use is the primary reason for the visit.
What the template captures
Substance use, cravings, and withdrawal
The template documents substance type, route of administration, frequency and quantity, duration of use, and time since last use for every substance the patient reports, plus age of first use and how the patient obtains the drug. Craving intensity and pattern sit next to withdrawal symptoms and their timing relative to last use, because withdrawal risk sets the urgency and setting of care: severe alcohol or benzodiazepine withdrawal can be dangerous enough to require inpatient management.
Level of care under ASAM
The American Society of Addiction Medicine (ASAM) criteria set the standard for matching a patient to a level of care, from outpatient to residential treatment, across six dimensions: intoxication or withdrawal risk, biomedical conditions, emotional and behavioral conditions, readiness to change, relapse risk, and the recovery environment. The template gives each dimension its own field, so the note documents why a patient meets a specific level, not only which level was chosen, a distinction that matters if a payer reviews the placement decision later.
Safety assessment
This section separates suicidal and homicidal ideation (passive versus active, with or without a plan), prior self-harm or attempts, access to lethal means, and protective factors such as family support and treatment engagement. It also carries an attestation that the clinician reviewed the state's prescription drug monitoring program (PDMP), the database that tracks a patient's controlled-substance prescriptions across pharmacies and prescribers, before prescribing.
From assessment to diagnosis code
Once the picture is complete, the note still needs a diagnosis. JotPsych rebuilt the behavioral health section of its built-in diagnosis code list to keep up: the International Classification of Diseases, 10th revision (ICD-10) code picker, the tool clinicians use to search for and attach a diagnosis code inside the note, was refreshed for fiscal year 2026 and now covers substance-related and every other behavioral health diagnosis in far more detail.
- 1Intoxication and withdrawal potential
- 2Biomedical conditions and complications
- 3Emotional, behavioral, and cognitive conditions
- 4Readiness to change
- 5Relapse and continued-use potential
- 6Recovery environment
The six dimensions the American Society of Addiction Medicine (ASAM) requires behind a level-of-care decision, each its own field in JotPsych's addiction assessment template. Source: ASAM Criteria. A note that fills all six shows why a patient meets a level of care, so a payer reviewing the placement later reads the reasoning instead of asking for it.
The template in JotPsych is one of 25+ pre-built templates in the public library, alongside psychiatric intake, therapy, medication management, and CPT-coded visit templates. Selecting it before the encounter sets the structure, and the note's sections fill in from the recording as the visit happens. Editing a shared template never changes JotPsych's original: the first edit automatically creates the clinician's own copy, so customizing the template for a specific population does not touch the version the rest of the practice uses.
“Very happy, fast, accurate, builds rapport. The template builder is exactly what I needed.”Prescribing psychiatrist, private practice
A thorough intake protects the patient and the record.
See JotPsych's templatesSource: JotPsych. Level-of-care criteria per the American Society of Addiction Medicine. Testimonial: JotPsych clinician feedback.