Forms and Toolkits

Useful Tools

ALZ Direct Connect Referral Form: Referral to free of cost service providers by the Alzheimer's Association, California Southland Chapter. 

The AUDIT (Alcohol Use Disorders Identification) Test

The AUDIT Guide

ADHD Provider Resource Toolkit developed by the National Initiative for Children's Healthcare Quality. 

Behavioral Health in Medi-Cal

Behavioral Health Provider Toolkit

Behavioral Health Screening Tool (GAD-2, PHQ-2, and SHA)

Behavioral Health Toolkit for PCPs

Institute for Mental Disease (IMD) Referral Request Form

CCI: Cal MediConnect Provider Toolkit

Consent for the Release of Confidential Information Sample consent form for the release of confidential information when refer members for substance use disorder (SUD) assessment/treatments or exchange of SUD information.

Depression Provider Toolkit courtesy of MacArthur Foundation Initiative on Depression and Primary Care. PRIME-MD® Patient Health Questionnaire - Copyright © 1999 Pfizer Inc. MacArthur Toolkit - Copyright April 2009 3CM, LLC. Used with permission.

DHCS FAQs on TAR Restriction on Antipsychotic Medications for the 0-17 Population

DHCS SBIRT Easy to navigate, user friendly and frequently updated DHCS website on SBIRT resources.

Drug Interactions Checker Quick access to information on specific drug-and-drug or multiple drug interactions.

L.A. Care Behavioral Health Support to Providers

Level of Care Screening Form

Opioid Risk Assessment Tools PainEDU.org provides free interactive and downloadable pain management and assessment tools.

Opioid Risk Management and Behavioral Health Services (PPT)

Opioid Treatment Agreement Form Sample of Opioid Treatment Agreement Form.

PC-PTSD is a four-item screen designed for use in primary care and other medical settings to screen for Post-Traumatic Stress Disorder. 

PHQ- 9 and GAD-7 The PHQ-9 is the most common screening tool to identify depression. The GAD-7 is a screening tool that identifies whether a complete assessment for anxiety is indicated.

Primary Care MoodCheck for Bipolar Disorder A comprehensive Screening tool for Bipolarity in Primary Care. Detailed instructions and useful information on Bipolar disorder can be found here.

Understanding ICD-10-CM and DSM-5 is a quick guide for psychiatrists and other mental health clinicians provided by the American Psychiatric Association.

SBIRT Implementation (PPT)

Staying Healthy Assessment Questionnaire (SHA)

Suicide Assessment Five-step Evaluation and Triage (SAFE-T) (PDF)