Service User Plan (SUP)

Service User Plan Form

OST

Dose and collections:

Storage (locked / unlocked): Naloxone (yes / no):

ENGAGEMENT

Date of last attended medical review:

Missing consecutive appointments (yes / no):

OUTSTANDING ACTIONS FROM LAST MEDICAL REVIEW

DRUGS AND ALCOHOL (method, frequency, amount)

LAST DRUG SCREEN

Method: Date:

Positives:

Amphetamine

Opiates

Morphine

Cocaine

EDDP

Methadone

Benzodiazepine

Buprenorphine

Cannabis

Fentanyl

Tramadol

6 MAM

Methamphetamine

Ketamine

Nitazene

Xylazine

Oxycodone

TOPS

Date of last TOPS:

BBVs

Completed (yes / no): (Risk details):

PHYSICAL HEALTH

GP summary received within the last 12 months (yes / no):

Physical health problems:

MENTAL HEALTH

Thoughts to harm self or others (yes/no):

Mental health problems:

PRESENTATION

Concerns (yes/no):

CHILDREN

Any children that live or spend time in the home (yes/no):

SOCIAL

Stable accommodation (yes/no):

RISK CONCERNS AND HOW THESE ARE BEING MITIGATED

OBSTACLES TO PROGRESS

SERVICE USER PLAN / NOTES

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