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Anchor Progress Notes
Name
First
Last
Session Date
MM
/
DD
/
YYYY
Topics Covered
ASAM Dimensions
Primary
Choose Dimension
ASAM Dimension I
ASAM Dimension II
ASAM Dimension III
ASAM Dimension IV
ASAM Dimension V
ASAM Dimension VI
Secondary
Choose Dimension
ASAM Dimension I
ASAM Dimension II
ASAM Dimension III
ASAM Dimension IV
ASAM Dimension V
ASAM Dimension VI
Participation
(1-2 Low)
(3-4 Good)
(5-Excellent)
Low
1
2
3
4
5
Excellent
Notes
Counselor / Instructor
Counselor / Instructor
Signature
Clear