Clinical Templates - Adults' Services

The following files are in Microsoft Word template format.  Please download the file and save on it on your local computer for future use.

Authorization and CQRT  

• Authorization Request

Initial Assessment  

• Sample Medi-Cal Compliant Initial and Annual MH Assessment

Worksheets   

• ACBH SMHS Outpatient Medi-Cal Included List by DSM-5 Name
• ACBH SMHS Outpatient Medi-Cal Included Crosswalk
• GMC Codes
• ACBHCS Psychosocial Conditions by DSM Name

Medication Support  

• Sample Medi-Cal Compliant Psychiatric Mental Health Assessment:  PDF    Word
• Sample Medi-Cal Compliant Psychiatric Mental Health Client Plan:  PDF    Word

Progress Notes  

• Sample Medi-Cal Compliant Outpatient MH Progress Note:   PDF   Word
• Day Intensive
• Day Rehabilitation Weekly Summary
• Medication Support
• Adult
• Residential Monthly Reviews
• Residential Weekly Summaries

Treatment Plan  

• Sample Medi-Cal Compliant MH Treatment Plan:   PDF   Word
• Medication Support - Forthcoming

Other  

• Community Function - Annual
• Discharge Summary
• Medication Consent Forms