> ## Documentation Index
> Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt
> Use this file to discover all available pages before exploring further.

# Co-Occurring Disorder (COD) Integrated Documentation — User Guide

> The COD indicator unlocks the integrated treatment plan and dual-diagnosis progress note. You can set it two ways:

**Compliance:** AHCCCS AMPM Policy 320-O, CARF Behavioral Health Standards §§4.A–4.C, 42 CFR Part 2.
**Last Updated:** 2026-05-12

***

## 1. What COD documentation does

CL-31 lets you document an integrated assessment, treatment plan, and progress notes for clients with both a mental-health (MH) and a substance-use (SUD) diagnosis ("co-occurring disorder"). It adds three things on top of the standard chart:

* A **COD assessment tab** with ASI-6, BASIS-32, and GAIN-SS instruments.
* A **COD treatment plan extension** with ASAM level of care and dimensions 5/6 notes.
* A **dual-diagnosis progress note section** that records SUD content under 42 CFR Part 2 consent.

## 2. Marking a chart as COD

The COD indicator unlocks the integrated treatment plan and dual-diagnosis progress note. You can set it two ways:

1. **Automatic prompt** — After you save your first COD assessment for a chart, the platform asks "Set COD Indicator?". Click **Set COD Indicator** to mark the chart.
2. **Manual toggle** — Use the COD badge near the patient name in the chart header at any time.

The badge displays "COD" as a muted tag once set. Removing the indicator does not delete COD assessments — it only hides the integrated plan/progress-note sections.

## 3. Creating an ASI-6 assessment

1. Open the patient's chart and select the **COD Assessments** tab.
2. Click **New Assessment**. The assessment dialog opens.
3. Choose **ASI-6** as the instrument type at the top.
4. Expand each of the seven domains (Medical, Employment, Alcohol, Drug, Legal, Family/Social, Psychiatric) and enter a composite score 0–9. The severity badge is computed automatically (0–1 None, 2–3 Low, 4–5 Moderate, 6–9 Severe).
5. Add interviewer notes per domain. Notes are optional for **Save Draft** and required for **Complete Assessment**.
6. Click **Save Draft** to keep working, or **Complete Assessment** to finalize.
7. The dialog header shows "X of 7 domains scored" so you can track progress.

> **About SUD domains (Alcohol, Drug):** You can always enter assessment scores. Read access for other users is gated by 42 CFR Part 2 consent — see §7.

## 4. BASIS-32 and GAIN-SS (Phase 2 generic form)

The Phase 2 release captures BASIS-32 and GAIN-SS as a single total-score plus summary notes. The full subscale UI ships in the Phase 3 release. The instrument header shows: "Full subscale breakdown coming in a future release."

## 5. Amending a complete assessment

On any assessment with status **Complete**, click **Amend** in the row's actions. The form reopens. Save your changes; the status moves to **Amended** and the original is preserved in the audit log.

## 6. COD treatment plan extension

When a chart has the COD indicator set, the standard CL-03 treatment plan adds a collapsible **Co-Occurring Disorder (COD) Level of Care** section between the Goals section and the signatures.

* **ASAM level** — Pick from 0.5 through 4.0. Leave blank for "Not yet determined."
* **Dimension 5 / Dimension 6 notes** — Optional free-text fields for relapse potential and recovery environment.
* **Goal tagging** — Each treatment goal gets a Domain chip: MH, SUD, or Both. Defaults to Both when COD is set. Keep goal descriptions general; document SUD-specific details in the progress note SUD section.
* **MOUD link** — When CL-21 (MOUD) is enabled and a MOUD episode is linked, a read-only callout shows medication, current phase, and start date.

## 7. Writing a dual-diagnosis progress note

1. Create a progress note as usual (CL-04). When the chart's COD indicator is set, a **COD Session Type** selector appears with options **Standard (MH only)** and **Dual Diagnosis (COD)**.
2. Pick **Dual Diagnosis (COD)** and save the note.
3. Re-open the saved note. If the patient has an active 42 CFR Part 2 consent on file, the SUD section renders four fields:
   * SUD symptom summary
   * Substance use since last session
   * Cravings and urges
   * Treatment response
4. If consent is missing, the SUD section is replaced with an amber banner: "SUD documentation requires 42 CFR Part 2 consent." Click **Manage Consent →** to open the CL-11 consent workflow.
5. The consent check runs on every form load — you cannot bypass it.

## 8. Managing consent

Consent is captured in CL-11. Open the **Consent** section of the chart, add a `sud_counseling_notes` consent for the disclosure recipient, and have the patient sign. Once active, the SUD section unlocks for any clinician with `cl.cod_progress_notes.view_sud`.

## 9. FAQs

**Why can I enter SUD scores but not always read them later?**
Entering data is gated by your role permissions; reading SUD content (notes, redisclosure exports) is gated by patient consent under 42 CFR Part 2. Default-deny applies on any consent-check failure.

**Can I edit the auto-derived severity badge?**
No. Severity is a deterministic function of the composite score in Phase 2.

**The COD prompt did not appear after my first assessment.**
The prompt fires once per browser session per chart. If you dismissed it, set the COD indicator manually from the chart header.

**Where do I see all my COD patients?**
The COD Caseload view ships in Phase 3 (see CL-31 spec §US-5).

## 10. Related guides

* [Consent management user guide](/cl/consent-management-user-guide) (CL-11)
* [Clinical reporting and quality measures user guide](/cl/clinical-reporting-quality-measures-user-guide) (CL-15)