Social Elements Impacting Diagnosis (Check all that apply): None Access to Health Care Housing Problems Social Environment Educational Legal System/Crime Occupational Homelessness Financial Primary Support Other Psychosocial/Enviro. Unknown Individual experiences at least 3 of the following: Inability to maintain independent employment Severe inability to establish or maintain social supports Social behavior that results in interventions by the mental health system Need or assistance with basic living skills Inability, due to cognitive disorganization, to procure financial assistance to support living in the community If the individual has a co-occurring Substance Use Disorder (cannot be primary diagnosis) ICD-9 ICD-10 DSM 5 Diagnosis ICD-9 ICD-10 DSM 5 Diagnosis Stimulant-Related Disorder Cocaine – 305.00 F10.10 Alcohol Use Disorder Mild 304.20 F14.20 – Severe – Alcohol Use Disorder Stimulant-Related Disorder – – 303.90 F10.20 305.70 F15.10 Moderate Amphetamine-type substance Mild – Stimulant-Related Disorder – 303.90 F10.20 Alcohol Use Disorder Severe 304.40 F15.20 Amphetamine-type substance – – Moderate Stimulant-Related Disorder – 305.20 F12.10 Cannabis Use Disorder Mild 304.40 F15.20 Amphetamine-type substance – – Severe Cannabis Use Disorder – 304.30 F12.20 305.1 Z72.0 Tobacco Use Disorder Mild – Moderate Cannabis Use Disorder – 304.60 F12.20 305.1 F17.200 Tobacco Use Disorder Moderate – Severe 305.50 F11.10 Opioid Use Disorder Mild 305.1 F17.200 Tobacco Use Disorder Severe – – Opioid Use Disorder Other (or Unknown) Substance Use – 304.00 F11.20 305.90 F19.10 Moderate Disorder Mild – Other (or Unknown) Substance Use 304.00 F11.20 Opioid Use Disorder Severe 304.90 F19.20 – Disorder Moderate – Stimulant-Related Disorder (or Unknown) Substance Use – 305.60 F14.10 304.90 F10.20 Cocaine Mild Disorder Severe – – Stimulant-Related Disorder Stimulant-Related Disorder Cocaine – – 304.20 F14.20 304.20 F14.20 Cocaine Moderate Severe – – Include any secondary Behavioral Health Diagnoses (If any): Medical Diagnoses (If any):
Social Elements Impacting Diagnosis (Check all that apply): None Access to Health Care Housing Problems Social Environment Educational Legal System/Crime Occupational Homelessness Financial Primary Support Other Psychosocial/Enviro. Unknown Individual experiences at least 3 of the following: Inability to maintain independent employment Severe inability to establish or maintain social supports Social behavior that results in interventions by the mental health system Need or assistance with basic living skills Inability, due to cognitive disorganization, to procure financial assistance to support living in the community If the individual has a co-occurring Substance Use Disorder (cannot be primary diagnosis) ICD-9 ICD-10 DSM 5 Diagnosis ICD-9 ICD-10 DSM 5 Diagnosis 305.00 F10.10 Alcohol Use Disorder – Mild 304.20 F14.20 Stimulant-Related Disorder – Cocaine – Severe 303.90 F10.20 Alcohol Use Disorder – Moderate 305.70 F15.10 Stimulant-Related Disorder – Amphetamine-type substance – Mild 303.90 F10.20 Alcohol Use Disorder – Severe 304.40 F15.20 Stimulant-Related Disorder – Amphetamine-type substance – Moderate 305.20 F12.10 Cannabis Use Disorder – Mild 304.40 F15.20 Stimulant-Related Disorder – Amphetamine-type substance – Severe 304.30 F12.20 Cannabis Use Disorder – Moderate 305.1 Z72.0 Tobacco Use Disorder – Mild 304.60 F12.20 Cannabis Use Disorder – Severe 305.1 F17.200 Tobacco Use Disorder – Moderate 305.50 F11.10 Opioid Use Disorder – Mild 305.1 F17.200 Tobacco Use Disorder – Severe 304.00 F11.20 Opioid Use Disorder – Moderate 305.90 F19.10 Other (or Unknown) Substance Use Disorder – Mild 304.00 F11.20 Opioid Use Disorder – Severe 304.90 F19.20 Other (or Unknown) Substance Use Disorder – Moderate 305.60 F14.10 Stimulant-Related Disorder – Cocaine – Mild 304.90 F10.20 (or Unknown) Substance Use Disorder – Severe 304.20 F14.20 Stimulant-Related Disorder – Cocaine – Moderate 304.20 F14.20 Stimulant-Related Disorder – Cocaine – Severe Include any secondary Behavioral Health Diagnoses (If any): Medical Diagnoses (If any):
Application-Supported-Living-PRP.docx