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Behavioral Health Hub Department of Psychiatry

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Forms & Tools

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

 

 

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Behavioral Health Hub Department of Psychiatry
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