Primary Drug of Choice Secondary Drug of Choice Tertiary Drug of Choice Forth Drug of Choice Fifth Drug of Choice Method of Use Method of use Method of Use Method of Use Method of Use Oral, Smoking, Inhalation, Injection, Other Unknown Number of Days Since Last Use: Indicate the number of days since last use by entering a value between 0 and 30 Primary Drug of Choice Secondary Drug of Choice Tertiary Drug of Choice Forth Drug of Choice Fifth Drug of Choice Last Use Last Use Last Use Last Use Last Use 0 to 30 Days Age at which the client first used the Drug: Primary Drug of Choice Secondary Drug of Choice Tertiary Drug of Choice Forth Drug of Choice Fifth Drug of Choice Age at First Use Age at First Use Age at First Use Age at First Use Age at First Use Age
Primary Drug of Choice Method of Use Secondary Drug of Choice Method of use Tertiary Drug of Choice Method of Use Forth Drug of Choice Method of Use Fifth Drug of Choice Method of Use Oral, Smoking, Inhalation, Injection, Other Unknown Number of Days Since Last Use: Indicate the number of days since last use by entering a value between 0 and 30 Primary Drug of Choice Last Use Secondary Drug of Choice Last Use Tertiary Drug of Choice Last Use Forth Drug of Choice Last Use Fifth Drug of Choice Last Use 0 to 30 Days Age at which the client first used the Drug: Primary Drug of Choice Age at First Use Secondary Drug of Choice Age at First Use Tertiary Drug of Choice Age at First Use Forth Drug of Choice Age at First Use Fifth Drug of Choice Age at First Use Age
HMIS%2BPATH%2BIndividuals%2BDischarge%2BForm%2B-%2B7.2.docx