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Victoria

Youth Empowerment
Society

SPECIALIZED YOUTH DETOX: YOUTH SUMMARY FOR PHYSICIANS

To: _________________________________________________________________________________________
Website:
www.vyes.ca

Re: _________________________________________________________________________________________

YES Office

Accepted into SYD on:_______________________ Discharged on: ______________________________________

533 Yates Street


Victoria, BC V8W 1K7
Phone: (250) 383-3514
Fax: (250) 383-3812
E-Mail:
office_manager@vyes.ca

533 Daytime Drop-In


Mental Health Liaison
Program
Summer
Opportunities
Program
Volunteer Program

Youth Services
Phone: (250)383-3514
Outreach Program
Supported
Independent
Living Program
Life Skills Program

The Alliance Club


Phone: (250) 361-3923
Youth Phone: (250) 3827553
E-Mail:
allianceclub@vyes.ca

Specialized Youth
Detox (SYD)

Phone: (250) 383-3514


Fax: (250) 383-3812
E-Mail: syd@vyes.ca

Kiwanis Emergency
Youth Shelter
(KEYS)
2117 Vancouver
Street
Victoria, BC V8T 3Z9
Phone: (250) 386-8282
Fax: (250) 384-0778
E-Mail: keys@vyes.ca

Youth & Family


Funded
By:
Support
Services
Federal
Phone: Government,
(250) 386HRSDC,
8282 the Province of
BC,
Ministry
of Children
Fax:
(250) 384-0778

and
Family
E-Mail:
yfss@vyes.ca
Development,
Vancouver Island Health
Authority, United Way,
City of Victoria, Victoria
Business Community,
Corporations, Private
Donations, Various
Grants, Individual
Donors, Fundraising
Events

Completed SYD Program (7 or more days): YES NO Days:___________________________________________


Reason of Discharge:___________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Withdrawal Medications provided:

YES

NO

Number of Days Withdrawal Medication used for:____________________________________________________


Changes/Concerns with Withdrawal Medication:_____________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Additional Medical Services While in SYD:___________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
__________________________________________________________________________________________
Post Detox Plan:_______________________________________________________________________________

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Staff Signature:_____________________________________________Date:______________________