Form Dhcs 5086 - California Weekly Schedule Of Recovery, Treatment, Or Detoxification Services - Health And Human Services Agency

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State of California — Health and Human Services Agency
Department of Health Care Services
Licensing and Certification Branch, MS 2600
PO Box 997413
Sacramento, CA 95899-7413
A-6 – WEEKLY ACTIVITIES SCHEDULE
WEEKLY SCHEDULE OF RECOVERY, TREATMENT, OR DETOXIFICATION SERVICES
(Include individual/group education sessions, recovery or treatment planning)
ARE DETOXIFICATION SERVICES PROVIDED AT THE FACILITY (please check):
YES
NO
Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
6-7 a.m.
7-8 a.m.
8-9 a.m.
9-10 a.m.
10-11 a.m.
11 a.m.-12
12-1 p.m.
1-2 p.m.
2-3 p.m.
3-4 p.m.
4-5 p.m.
5-6 p.m.
6-7 p.m.
7-8 p.m.
TOTAL HOURS PER WEEK OF INDIVIDUAL/GROUP/EDUCATION SESIONS, RECOVERY OR TREATMENT
PLANNING, AND DETOXIFICATION SERVICES (IF PROVIDED):
Comments:
DHCS 5086 (07/13)

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