| Family name and forename |
| Present address and postcode |
| Unique identifier |
| Previously known |
| Date of birth |
| Gender |
| Ethnicity |
| Referral Source |
| G.P Name |
| G.P Address |
| Other professionals/agencies involved |
| Next of kin |
| Dependant children at home |
| Previously known |
| Previous Interventions |
| Presenting problem |
| Primary drug profile |
| Secondary drug profile |
| Injecting |
| Signs and symptoms of over sedation and/or withdrawal |
| Consent to assessment |
| Signed permission to share information with other agencies |
2. Assessed Need core data set |
Drug Use |
| Other problem drug profile |
| Alcohol use |
| Prescribed drugs/medication |
| Effects on user (positive and negative) |
| Problems/concerns |
| Drug history including alcohol |
Living Arrangements |
| Household composition |
| Status of residency |
| Accommodation type |
| Carer/cared for |
| Other drug user(s) in household |
| Housing support needs |
| Benefits |
| Heating |
Physical Health |
| Past medical history |
| Permanent or long-standing health condition or disability |
| Current care provision |
| Seen by GP in last 18 months |
| Current medical condition |
| Current medication |
| Current treatments |
| Registered disabled |
Disease Prevention |
| Sleep patterns |
| Diet and food preparation |
| General physical state |
| Body Mass Index |
| Injecting practices/techniques |
| Wound management |
| Oral health |
| Vaccination history |
| History of cervical or breast screening |
Mental Health |
| Past psychiatric history |
| Current signs and symptoms |
| Risk assessment |
| Current medication |
| Seen by psychiatric services in last 18 months |
| Current diagnosis |
Social Functioning |
| Relationships |
| Family contacts |
| Social contacts |
| Spiritual and religious matters |
| Cultural and ethnic matters |
| Leisure/hobbies |
| Employment, past and current |
| Learning |
Legal Situation |
| Current offending behaviour |
| Previous convictions |
| Outcomes |
| Prison |
| Other |
Service User's Perspective |
| Problems and issues perceived and conveyed by the person |
| Person's motivation |
| Advocacy required? |
Collateral Information |
| Carer/significant others' perspective |
| Other service provider |
Biological Measures |
| Biochemistry |
| Virology |
| Hepatitis B |
| Hepatitis C |
| HIV |
| Pregnancy |
Readiness to Change |
| Stage of change |
| Motivational state |
| Strengths |
| Barriers to change |
| Support system |
| Self-efficacy |
Risk and Safety |
| Needle sharing/exchange/cleaning |
| Sharing of injecting paraphernalia including filters, water and spoons |
| Sexual risk |
| Blood borne virus |
| Sexually transmitted diseases |
| Personal safety- Risk from self |
| Personal safety- Risk from other |
| Risk to dependant children |
| Public Safety |