Forms and Toolkits
ALZ Direct Connect Referral Form: Referral to free of cost service providers by the Alzheimer's Association, California Southland Chapter.
ADHD Provider Resource Toolkit developed by the National Initiative for Children's Healthcare Quality.
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 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.
Opioid Risk Assessment Tools PainEDU.org provides free interactive and downloadable pain management and assessment tools.
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.
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)