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Office of Mental Health

Assessment Forms and Addendums - Archived v2.0 Form Set (Current Version 3.0)

Form Usage Index
Form Element Glossary

Assessment Form Name PDF Forms Word Forms Form Descriptions
Brief Medical History PDF Document Word Document Word Document
Case Management Assessment PDF Document Word Document Word Document
Case Management Assessment Update PDF Document Word Document Word Document
Communicable Disease Assessment PDF Document Word Document Word Document
Comprehensive Assessment PDF Document Word Document Word Document
Comprehensive Assessment Update PDF Document Word Document Word Document
Immediate Needs Assessment PDF Document Word Document Word Document
Medication List PDF Document Word Document Word Document
Personal Information PDF Document Word Document Word Document
Personal Information Update PDF Document Word Document Word Document
Psychiatric Evaluation PDF Document Word Document Word Document
Psychiatric Evaluation Update PDF Document Word Document Word Document
Psychiatric Rehabilitation Readiness Determination PDF Document Word Document Word Document
Residential Functional Assessment - Adult PDF Document Word Document Word Document
Residential Functional Assessment - Child PDF Document Word Document Word Document
Residential Intake Assessment - OMH PDF Document Word Document Word Document
Self-Assessment PDF Document Word Document Word Document
Substance Use Assessment PDF Document Word Document Word Document
Summary List (Joint Commission - Clinics Attached to Hospitals) PDF Document Word Document Word Document

Addendum Form Name PDF Forms Word Forms Form Descriptions
Legal Involvement and History Addendum PDF Document Word Document Word Document
Legal Status Addendum PDF Document Word Document Word Document
Mental Status Exam Addendum PDF Document Word Document Word Document
Military Addendum Full Length PDF Document Word Document Word Document
Military Addendum Significant Others PDF Document Word Document Word Document
Sample Primary Care Physician Request Letter N/A Word Document Word Document

Comments or questions about the information on this page can be directed to Jon Rice (OMH)

While NYSCRI strives for accuracy, neither NYSCRI, OMH or OASAS (relative to Version 2.0 or prior work)   warranties NYSCRI’s products as being compliant with any laws, rules or regulations. These resources may be used voluntarily as supports to meet such requirements though providers are responsible for the services delivered, content documented and billing completed, independent of any NYSCRI resources being utilized.