Prepare for your survey

Use the survey guidance below to prepare for your certification survey and to demonstrate that your program can deliver Levels of Care consistent with the ASAM Criteria®.

The rating elements – The ASAM Level of Care Certification Manual contains the rating elements CARF will apply during the certification survey. Order the manual and thoroughly review it to understand the requirements and expectations of the rating elements for each Level of Care (LOC).

Resources – ASAM offers self-paced training courses and other resources to help you understand the rating elements and prepare for certification.

Self-assessment – Consider conducting a mock survey to identify any gaps between the requirements of the rating elements and actual practice, so that you may address them prior to survey.

Prepare records – Active and closed clinical records for each LOC being surveyed will be reviewed by the surveyor. For each LOC, the surveyor will select active records, while you will select closed records. Have all active records and select closed records available at all times during the survey. Every record should contain the results of the assessment, the treatment plan, and all other documentation as specified by the rating elements to be contained in the clinical record.

Questions – For questions about the certification process, contact the Certification Support Team at extension 7023 or For questions about how to meet the rating elements, visit ASAM or contact ASAM at

The certification rating elements are organized by setting, staff, support system, assessment and treatment plan, therapies, and documentation. This structure provides for ease of understanding and alignment with the six service characteristics categories described in the ASAM Criteria®.

Each LOC is separate and distinct and will be individually assessed for certification. You must be able to demonstrate to the surveyor during the survey that the rating elements are satisfied for each LOC included in the application for certification.

The certification decision for each LOC is determined based on scoring of the survey findings. The proprietary scoring methodology considers two factors:

  • Defining elements. In the certification manual, defining elements are highlighted. The defining elements for each LOC address areas deemed crucial by ASAM to the operation of all treatment programs that provide services at that LOC. All defining elements for a particular LOC must be satisfied to achieve certification for that LOC. Ensure that you can provide clear and unambiguous evidence to the surveyor that each defining element is satisfied. Note: To emphasize the importance of the defining elements, consider LOC 3.5, which has over 300 discrete rating elements. If most of the elements are met yet one defining element is missed, certification for LOC 3.5 will not be issued.
  • Non-defining elements. All other rating elements are non-defining elements. Satisfaction of all non-defining elements is not required; however, each LOC must substantially satisfy the non-defining elements to be issued certification.

Certification surveys are conducted on-site, unless a remote survey is indicated by CARF. See the sections labeled On-site surveys and Digitally enabled surveys below for more information.

Survey activities for all certification surveys include:

  1. Start. The surveyor will start the survey at the time determined during the pre-survey meeting, typically around 8:00 a.m.  (Details about the pre-survey meeting for each survey format are set forth in the On-site surveys and Digitally enabled surveys sections below.) The brief orientation includes introductions, an overview of the survey activities, and a review of the survey logistics.
  2. Tour. The surveyor will tour of all areas of the facility identified by the surveyor, including but not necessarily limited to: (1) building exterior, including street address display; (2) outside spaces available for patient use, including recreation activities; (3) monitoring and security of outside areas; (4) reception area for patients; (5) spaces for individual, group, and family therapy; (6) location of daily schedule, if posted; (7) meal area; (8) location of meal plan, if posted; (9) quiet spaces available for patient use; (10) visitation areas; (11) areas for staff supervision of patient activities, including cameras, monitoring stations, and other supervision methods, as applicable; (12) areas for awake night staff; (13) areas for LOC 3.7 nursing staff, if applicable; (14) areas between LOC 3.7 nursing staff and patient sleeping areas, if applicable; (15) patient sleeping areas; (16) storage area for patient belongings; and (17) bathrooms for patients based on gender, age, and needs.
  3. Document review. The surveyor will independently review documentation, with priority consideration of the defining elements.
  4. Preliminary findings for defining elements. Once preliminary findings are determined for the defining elements, the surveyor will inform you of any defining elements not yet rated as satisfied. You will have at least one hour to provide any additional information related to the defining elements while the surveyor continues to review documentation related to the non-defining elements.
  5. Clinical records review. You will guide the surveyor through the review of the clinical records.
  6. Wrap-up. After considering any additional information presented with respect to the defining elements, the surveyor will conduct a brief meeting to identify any defining elements not rated as satisfied. No additional information may be presented at this time. The surveyor will then conclude the survey. The certification decision will remain undetermined until CARF scores the surveyor’s findings. However, because all defining elements for each LOC must be satisfied for certification of that LOC to be issued, the identification of any defining elements during the wrap-up meeting will be informative.

The provider is at all times responsible for demonstrating to the surveyor that each LOC satisfies the applicable rating elements.

Based on the information presented, the surveyor will try to help you succeed. During the survey, the surveyor may ask questions about certain documents or request that you locate specific items that the surveyor is unable to find. The expectation, however, is that you have all information available and ready for the surveyor before the survey. Minimally, you must be able to readily produce any information upon request.

Pre-survey meeting

The surveyor will contact you to schedule a meeting via telephone or Microsoft Teams® (Teams) approximately 30 days before the survey. During the pre-survey meeting, the surveyor will confirm:

  • Location and LOC(s) to be surveyed.
  • That each and every defining element for the LOC(s) to be surveyed has been addressed.
  • Survey date(s) and start time.
  • If/how technology will be used for any survey activities, including what non-confidential documentation you will upload to Teams prior to the survey (if any). Documentation upload is at your discretion. CARF will notify you when the team is created in Teams. Review the Frequently Asked Questions for using Teams in connection with your survey.
Site preparation

Before the survey, prepare a quiet space for the surveyor to review documentation privately. The space should include all paper documentation and a dedicated computer (with restricted network access or preloaded files) to access any electronic documents and clinical records. Assign a staff member to orient the surveyor to the paper documentation, aid access to electronic documents, and guide navigation of clinical records.

The survey

The surveyor will arrive and commence the survey activities described above. If the survey is scheduled for two days, the surveyor will report the progress of the survey at the end of the first day and identify the next day’s activities.

The survey will be performed via digitally enabled format only if confirmed in writing by CARF.

Technology preparation

The digitally enabled survey will utilize Teams. Effective use of Teams requires that your facility has reliable high-speed internet service (at least 25 Mbps recommended) and a desktop or laptop compatible with Teams. Preferably, you will have at least one desktop or laptop and one or more mobile phones or tablets. At least one device must be mobile with video capabilities (laptop, tablet or mobile phone).

Shortly after scheduling the survey, CARF will ask you to identify any staff other than the Survey Key Contact who should be added as Teams guests to upload documentation (see the Site preparation section below). Thereafter, the Survey Key Contact and any other identified guests will receive an email notification from Microsoft to join Teams. Once you receive the Teams notification and before the pre-survey meeting (see the Pre-survey meeting section below), you should:

  • Enable Teams on all devices you will use during the survey. CARF recommends using the Teams application.
  • Sign in to Teams. If the Teams notification was sent to an email account that already has a Teams or Office 365 account established, use that account to sign in. If not, establish a free Teams account utilizing the email address that received the notification.
  • Become familiar with and test Teams. The survey will utilize the following Teams functionality: team “General” and “Organization” channels; and meetings (live video, audio and screen share). Recommended video training includes: Join a Teams meetingUpload and share filesJoin a meeting on the go; and Show your screen during a meetingAccessibility support for Teams is also available.
  • Participate in an interactive training module (approximately 30 minutes) to guide the use of Teams preparation for the survey. Note: The module is best viewed when using Microsoft Edge, Google Chrome, of Safari web browsers.
  • Review the Frequently Asked Questions for using Teams. For support using Teams in connection with your survey, contact the Certification Support Team at extension 7023 or
  • Depending on your needs and to provide communication alternatives in the unlikely event there are challenges during the survey using Teams video or audio, you may wish to consider enabling all devices with Google Meet® and/or FaceTime® to supplement Teams.
  • Identify and locate all written materials that demonstrate satisfaction with the applicable rating elements. Any documentation that does not exist in a supported electronic format under 100 GB (other than clinical records) should be scanned or otherwise converted to a supported format with a smaller file size. Wherever possible, the organization should save each electronic document using a file name that includes both the element number(s) to which it relates and the name of the plan, policy, procedure, or other document.
Pre-survey meeting

The surveyor will contact you to schedule a meeting via Teams approximately 30 days before the survey. During the pre-survey meeting, the surveyor will confirm:

  • Location and LOC(s) to be surveyed.
  • That each and every defining element for the LOC(s) to be surveyed has been addressed.
  • Survey date(s) and start time.
  • That you have sufficient familiarity with Teams to conduct the survey.
  • Any additional staff who should be added as Teams guests to upload documentation (see the Site preparation section below).
  • Whether Google Meet and/or FaceTime  will be utilized on any devices to supplement Teams during the  survey.
Site preparation

After the pre-survey meeting and at least five days before the survey, you must:

  • Review the General channel in Teams for posted information.
  • Upload to the Organization channel in Teams all documentation (excluding clinical records) that demonstrates satisfaction of the applicable rating elements, using folders to organize each document by rating element subsections (for example: Level 3.1, Section 1A – Setting and Level 3.5, Section 2B – Support Systems). Also, upload a sample clinical record, including but not limited to assessment and treatment plan templates. CARF may cancel or reschedule the survey if all necessary documentation is not uploaded to Teams at least five days before the survey. All uploaded materials will be deleted after the issuance of the certification decision. Do NOT send any documentation to the surveyor through email or any method other than uploading to Teams.
  • Do NOT upload any clinical records or other protected health or personal information. If any documentation includes protected health or personal information, you must redact such information before uploading.
  • Upload to the Organization channel in Teams a list of the record numbers of all current patients. If the privacy of health records is not protected by numbers agnostic of personal information, prepare a list of the names or birthdates of all current patients for the surveyor to view during the survey. Do not upload the names or birthdates to Teams.
The survey

The surveyor will sign in to Teams and commence the survey activities described above:

  • The orientation, guided organization tour, meeting to discuss preliminary findings for defining elements, and wrap-up meeting will be performed using live video and audio on a device enabled with Teams, Google Meet, or FaceTime. Traditional telephone calls may alternatively be used for the orientation and meetings, but the guided organization tour must be conducted using live video and audio.
  • Independent review of documentation (excluding clinical records) will be performed by the surveyor using the Teams Organization channel. Knowledgeable staff should be available at the surveyor’s request to facilitate the review of documentation using live video or audio.
  • Guided clinical records review, including the sharing of any lists of patients identifiers, will be performed using live video, audio, and screen sharing. Knowledgeable staff should facilitate the surveyor’s review of clinical records. Be prepared to scan for screen sharing all clinical records identified by the surveyor for review during the survey.
  • When the surveyor schedules each survey activity, your Survey Key Contact should forward the meeting notification email to the appropriate staff (if other than your Survey Key Contact).
  • If the survey is scheduled for two days, the surveyor will report the survey progress to the organization at the end of the first day and identify the next day’s activities using live video or audio.

After the survey, the surveyor will submit the survey findings to CARF to determine the certification decision based on whether, for LOC surveyed, your organization demonstrated satisfaction of all defining elements and substantial satisfaction of the non-defining elements. Certifications are effective for three years.

If your program is certified, you must submit a Plan of Action (POA) to CARF within 90 days of the certification decision. The POA must address all rating elements that were not satisfactorily demonstrated during the survey. Certified programs must also submit annual reports to CARF that attest to ongoing satisfaction of the elements.

Programs not issued certification will receive a POA to identify the elements not satisfied and the areas that should be addressed for any future certification efforts.

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