Horizon House Sober Living — Discharge Report
Member Information
Member Name
Date of Discharge
House (Men/Women)
Staff Completing Report
Reason for Discharge
Relapse
Behavioral violation
Threats or violence
Non‑compliance with house rules
Other (explain)
Incident Description
Relapse Details (if applicable)
Type of Test
Urine
Breathalyzer
Oral Swab
Other
Test Result
Positive
Negative
Refused (treated as positive)
Substances Detected
Date/Time Test Administered
Behavioral Details (if applicable)
Behavioral Violation Type
Behavioral violation
Threats or violence
Non‑compliance with house rules
Other (explain)
Description of Behavior
Staff Observations
Member Response / Statement
Safety & Exit Procedures
Member gathered belongings
Room inspected
Member left without incident
Transportation arranged
Emergency contact notified
Provided detox/IOP resources
Member declined resources
Police/EMS involvement (if any)
Follow‑Up Recommendations
Detox
Residential treatment
IOP
Eligible to return after treatment
Not eligible to return
Other Recommendations
Signatures
Staff Signature (typed)
Date
Member Signature (if cooperative)
Date
Submit Discharge Report