BHU Note

D: Client is a [comment memo="Age"][text name="variable_1" default=""] year old, [comment memo="Marital Status"][text name="variable_2" default=""], [comment memo="Race/Ethnicity"][text name="variable_3" default=""], [comment memo="Reported Gender"][text name="variable_4" default=""] with a reported history of drug use that began at age [comment memo="Age of First Use of any Substance"][text name="variable_5" default=""] and opiate use that began around age [comment memo="Age of First Use of any opiate"][text name="variable_6" default=""].  Client has [comment memo="Number of Children- use no if none"][text name="variable_20" default=""] children.  Client reports [comment memo="Living Environment and who they live with"][text name="variable_7" default=""].  Client reports living environment [select name="variable_8" value="is|is not"] safe, stable, and drug free. Client reports [comment memo="Current Medical Conditions"][text name="variable_9" default=""], with the last PCP visit being [comment memo="Last PCP Visit"][text name="variable_10" default=""], and reported [comment memo="Current medications"][text name="variable_11" default=""] when asked about current medications prescribed.  Client reports [select name="variable_11" value="no history of being diagnosed past or present|history of being diagnosed past or present with|current symptoms of"] mental health conditions. Client [select name="variable_12" value="reports|denies"] DTS/DTO at this time. Client [select name="variable_13" value="reports|denies"] experience of or being a witness to domestic violence in the last 12 months.

Client reports employment status as [comment memo="Employment Status, Job Title, Full Time or Part Time, and if they are actively seeking current/better employment"][text name="variable_14" default=""].  Client reported highest level of education as [comment memo="Highest Formal Education"][text name="variable_15" default=""] and reports they [select name="variable_16" value="are|are not"] currently enrolled in a vocation/education program.  Client reports participation in social or cultural activities which include [comment memo="Social/Cultural/Community Participation"][text name="variable_17" default=""]. Client reports [comment memo="Natural/Family Supports"][text name="variable_18" default=""] and [select name="variable_19" value="does|does not"] want family involved in treatment at this time.