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[]
[null,"Needs Questionnaire "]
[]
[]
[]
[]
[]
[null,"Assessment of Needs- May vary for different facilities and services offered there; still helps to collect info quickly"]
[]
[null,null," Recoveree Name"]
[null,null,"Phone #: ",{"$nulls":19},"Today's Date: "]
[null,null,"Recovery Coach Name: ",{"$nulls":19},"Next Appointment with RC:"]
[]
[]
[null,null,"Housing ",{"$nulls":12},"Employment ",{"$nulls":12},"Transportation "]
[null,null,"☐","Funding/Resources",{"$nulls":11},"☐","Resume",{"$nulls":11},"☐","Vehicle "]
[null,null,"☐","Transitional/Safe Housing ",{"$nulls":11},"☐","Job Service",{"$nulls":11},"☐","Medicaid Transportation"]
[null,null,"☐","Rent/Own/Shared Living Expenses ",{"$nulls":11},"☐","Training/college ",{"$nulls":11},"☐","Bicycle"]
[null,null,"☐",{"$nulls":12},"☐",{"$nulls":12},"☐","Insurance"]
[null,null,"☐",{"$nulls":12},"☐","Training/college ",{"$nulls":11},"☐"]
[null,null,"☐",{"$nulls":12},"☐",{"$nulls":12},"☐"]
[]
[]
[null,null,"Identification  ",{"$nulls":12},"Finances ",{"$nulls":12},"Recovery Wellness Support "]
[null,null,"☐","Driver's License ",{"$nulls":11},"☐","Employment /Temporary Unemploment",{"$nulls":11},"☐","Medications for Addiction Treatment (MAT/MOUD)"]
[null,null,"☐","Government Issued ID ",{"$nulls":11},"☐","Food Benefits ",{"$nulls":11},"☐","Assessment"]
[null,null,"☐","Birth Certificate ",{"$nulls":11},"☐","SSI (Social Security)",{"$nulls":11},"☐","Funding Sources"]
[null,null,"☐","Social Security Card ",{"$nulls":11},"☐","Disability (SSD)",{"$nulls":11},"☐","Support Meetings "]
[null,null,"☐",{"$nulls":12},"☐","VA Benefits",{"$nulls":11},"☐"]
[null,null,"☐",{"$nulls":12},"☐",{"$nulls":12},"☐"]
[{"$nulls":15},"☐",{"$nulls":12},"☐"]
[]
[null,null,"Recovery Wellness Support ",{"$nulls":12},"Support Tools ",{"$nulls":12},"Physical Health  "]
[null,null,"☐","Stabilization ",{"$nulls":11},"☐","12 Step Fellowships",{"$nulls":11},"☐","Funding"]
[null,null,"☐","Evaluation ",{"$nulls":11},"☐","Sponsor",{"$nulls":11},"☐","Medical Provider"]
[null,null,"☐","Provider",{"$nulls":11},"☐","Faith-based",{"$nulls":11},"☐","Medication"]
[null,null,"☐","Medication/Med Management",{"$nulls":11},"☐","Grief Support",{"$nulls":11},"☐","Dental "]
[null,null,"☐","Counseling",{"$nulls":11},"☐","Recovery Coach ",{"$nulls":11},"☐","Sleep"]
[null,null,"☐",{"$nulls":12},"☐","Sober Activities ",{"$nulls":11},"☐","Hygiene"]
[]
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[null,null,"☐","Upcoming Court Dates",{"$nulls":11},"☐","Clothing",{"$nulls":11},"☐","Medical Provider"]
[null,null,"☐","Warrants",{"$nulls":11},"☐","Coats",{"$nulls":11},"☐","Homelessness"]
[null,null,"☐","Drug/DUI/MH/VA Court",{"$nulls":11},"☐","Sleeping Bag/Bedding ",{"$nulls":11},"☐","Medication"]
[null,null,"☐","Community Service ",{"$nulls":11},"☐","food stamps ",{"$nulls":11},"☐","Food "]
[null,null,"☐","CPS",{"$nulls":11},"☐",{"$nulls":12},"☐"]
[]
[]
[{"$nulls":14},"Budget"]
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[]
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