S02 D.3 Residential Exit Form.pdf

The document is a Residential Treatment Exit Form Worksheet dated 10/1/2024, designed to comprehensively document a veteran's status upon completing a residential treatment program. The form captures detailed information across multiple domains, including the veteran's housing arrangement, employment status, financial benefits, income sources, and follow-up treatment arrangements for various potential health and social challenges such as alcohol problems, drug problems, mental health issues, medical concerns, and vocational skill deficits.

Key sections of the form include tracking billable days and cost of care, reasons for program exit, housing stability, living arrangements, employment status, VA and non-VA financial benefits received, income sources, non-cash benefits, and clinical treatment follow-up plans. The form is specifically used for documenting exit information for veterans from Grant and Per Diem (GPD) programs, HCHV Low Demand Safe Haven, and other residential treatment services, providing a comprehensive overview of a veteran's status at the conclusion of a treatment program.