Admission Decision Form — Roots to Recovery

This form is completed by the Facility Manager (or delegated senior staff member) after reviewing the prospective Resident's Screening & Admission Form (DOC-02). It records the staff risk assessment and the formal admission decision (Admit, Defer or Decline). Decisions are recorded in the Resident's profile in Trellis on submission.

SECTION A — RESIDENT IDENTIFICATION

Resident Full NamesR2R-ID (issued at screening) *Date of Screening Form completionReviewed by (Facility Manager / Senior Staff) *Date of this Decision *

SECTION B — RISK ASSESSMENT

Rate each risk area Low / Medium / High based on what was disclosed on the Screening Form (DOC-02) and any clinical input.

Risk Area	Low / Medium / High	Notes and Action Required
Withdrawal / relapse risk
Self-harm or suicide risk
Risk of harm to others
Medical complexity
Mental health complexity
Legal pressures
Family / social instability
Financial pressures
Programme engagement risk
Other identified risk

SECTION C — ADMISSION DECISION

Decision *Notes / reasons supporting decisionRoom type allocated *Room / Bed numberMonthly fee (R) *Buddy / Mentor allocatedDate of planned admission *Time of planned admissionSpecial arrangements required (mobility, dietary beyond vegetarian, medication storage, other)

SECTION D — IF DECISION IS DEFER

What must happen before reconsidering? *Earliest reconsideration date *Person responsible for follow-up

SECTION E — IF DECISION IS DECLINE

Reason for decline *Referral suggested to (other facility, programme, none)Communicated to applicant on (date)Communicated by (full name)

SIGN-OFF

Facility Manager / Senior Staff (decision-maker)

Full NamePositionDate

Counsellor / Clinical input (where consulted)

Full NamePositionDate