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Ardu Recovery Center
Rehab Center in Utah
Medicaid Information
Most Insurances Accepted!
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801.810.1234
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Home
About Us
Drug and Alcohol Rehab Center in Utah
Utah Addiction Specialists
Holistic Approach To Addiction Treatment
Medical Detox
Detox Center Programs
Drug Detox Center
Alcohol Detox Center
Opioid Detox Center
Opiate Detox Center
Heroin Detox Center
Benzodiazepine Taper Program
Residential Treatment
Dual Diagnosis Treatment Center
Mental Health Treatment Center
Depression Treatment Center
Experiential Treatment
Admissions
What To Bring To Rehab
Insurance Verification
Addiction
Cocaine Addiction
Crack Addiction
Heroin Addiction
Hydrocodone Addiction
Marijuana Addiction
Opiate Addiction
Prescription Drug Addiction
Understanding Alcoholism
Understanding Drug Addiction
Vicodin Addiction
Xanax® Addiction
Blog
Podcast
Contact
Home
About Us
Drug and Alcohol Rehab Center in Utah
Utah Addiction Specialists
Holistic Approach To Addiction Treatment
Medical Detox
Detox Center Programs
Drug Detox Center
Alcohol Detox Center
Opioid Detox Center
Opiate Detox Center
Heroin Detox Center
Benzodiazepine Taper Program
Residential Treatment
Dual Diagnosis Treatment Center
Mental Health Treatment Center
Depression Treatment Center
Experiential Treatment
Admissions
What To Bring To Rehab
Insurance Verification
Addiction
Cocaine Addiction
Crack Addiction
Heroin Addiction
Hydrocodone Addiction
Marijuana Addiction
Opiate Addiction
Prescription Drug Addiction
Understanding Alcoholism
Understanding Drug Addiction
Vicodin Addiction
Xanax® Addiction
Blog
Podcast
Contact
MEDICAID SCREENING
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MEDICAID SCREENING
Full Name
*
First
Last
Date of Birth
Date Format: MM slash DD slash YYYY
Medicaid ID number
Best number to reach you at
Email address
*
Do you have outside support?
*
Yes
No
Aside from treatment
Do you have any sex offense charges?
*
Yes
No
Do you have a way to pay for your co-pay’s for medication?
*
Yes
No
The card will be needed before entering treatment
Recent treatment stays in the last 90 days? If so where?
Have you been incarcerated in the last 90 days?
*
Yes
No
Do you have any court dates in the next 60 days? If so do you have family that will transport you there and back?
*
Are you on probation or parole? If yes, are you court ordered to treatment?
*
Past or present mental health diagnosis? If so what was it and who gave you the diagnosis?
*
Are you going to need to detox? If so off of what?
*
What have you used in the last 2 weeks? How much? How often?
*
Do you have any medical issues that would get in the way of participating in treatment?
*
Are you on any medications? If so, what are they? What dose?
*
Do you plan on going to sober living after treatment? If so where and how will you be paying for it?
*
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