New York State Unified Court System Drug Court Treatment Progress Form
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1
2DATE OF REPORT: / /
New York State Unified Court System
Drug Court Treatment Progress Form
REPORT PERIOD COVERING:
to
/ /
/ /
CLIENT INFORMATION
Name:
Drug of Choice:
Date of Admission:
Est Date of Completion:
Dkt#/SCI# (Court Use Only)
/ /
/ /
COURT INFORMATION
Court:
Case Manager:
Telephone:
FAX:
TREATMENT AGENCY
RECOMMENDATION
Treatment Agency Name:
Type/Modality:
Preparer's Signature:
Maintain Current Treatment Status
Referral for Additional Services
Consider for Completion
Program Counselor:
Program Contact:
Contact Telephone:
Revise Treatment Plan
Being Considered for Discharge
TREATMENT SCHEDULE
TREATMENT ATTENDANCE
P = Present E= Excused / A= Absent / L= Late (Dates of attendance is not required if in residential)
Month
# days/wk
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
# sessions/wk
#hrs/wk
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
TREATMENT AREAS
TOXICOLOGY
(P=Positive, N=Negative, L=Lab/Pending)
THC Her
Coc Bez
Amp PCP
Alc Meth Barb PM
Notes
Date
Treatment Area
N/A
E
G
I
NI
/ /
Attitude towards Treatment
/ /
Stability of med/psych health
/ /
Status of Entitlements
/ /
Family system status
/ /
Participates in all aspects of
/ /
Develop social support network
/ /
Educational/Vocational/Employme
/ /
Key: THC=THC; Her=Heroin; Bez=Benzodiazepine; Amp=Amphetamine; PCP=PCP;
TREATMENT SUMMARY/COMMENTS
Alc=Alcohol; Meth=Methadone; Barb=Barbituates; PM=Prescription Medication
(Please be specific and include recommendations, aftercare information, other relevant progress. Include program’s response to identified problems, changes in
treatment plan, achievements, and issues with which the court may be able to assist )
ANCILLARY SERVICES
(Indicate all services participant is attending)
# days/wk
#absences
#attended
Type of Service
Comments:
Comm. Service
Educ./Voc. Ed.
Med./Psych.
Parenting
Probation
Support Group
Other
*Include Page 2 for all Family Court Reports and Additional Comments (Page 2 is not required for Non-Family Court cases)
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