Forms
- Hub Fax Cover Sheet
- Mental Health Background Form
- Mental Health Background Form-Cover Letter
- Patient Consent and Authorization
- Patient Release of Information
- PCP Needs Assessment
- Provider Data Sheet
- Referral Packet
- Referral-Staffing Form
- Satisfaction Survey – Patient/Parent
- Satisfaction Survey – Physician
- Satisfaction Survey – Young Adult
Screening Tools
Please refer to the Primary Care Screening Algorithm for guidance on when to administer various screening tools. An alphabetical list of a variety of rating scales/ screening tools is located below.
- Columbia Suicide Severity Rating Scale
- GAD 7
- Pediatric Symptom Checklist-17 (PSC-17) – English
- Pediatric Symptom Checklist-17 (PSC-17) – Spanish
- Pediatric Symptom Checklist-17 (PSC-17) – Youth
- PHQ-9
- SNAP IV-18
- SWYC-12 Month
- SWYC-24 Month
- SWYC-36 Month