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Medical Records: Behavioral Health History Forms
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Adolescent Self-Report (ages 13-17)
Adolescent self-report which states that it is to be used in order to "help counselors understand--in your own words--why you are here and what difficulities you might be having".
Files
- Adolescent Self Report.doc( 414.72 Kb )
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Adult Personal History (ages 18 and over)
Adult personal history form designed for an individual to fill out prior to seeing a therapist.
Files
- Adult History Form.doc( 931.84 Kb )
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Child/Adolescent Personal History (ages 17 and under)
Child/Adolescent personal history form designed for an individual to fill out prior to seeing a therapist.
Files
- Child Adol History Form.doc( 860.16 Kb )
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Patient Discharge Medical and Behavioral Health
This policy is created to outline the process for the management and eventual discharge from service of difficult patients. This includes those who are perceived to be difficult with respect to recurrent hostile behavior, inappropriate use of FHC services, excessive non-compliance (including financial obligations), inappropriate use of controlled substances, or other patterns of behavior that represent excessive lack of respect or responsibility on the part of the patient.
Files
- Ac-14 Patient Discharge Medical.doc( 481.28 Kb )
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Psychosocial Assessment
Psychosocial Assessment form to be used by providers.
Files
- Psychosocial Assessment.doc( 701.44 Kb )
