Mental Health Information Management (MHIM) - Tulare HHSA

Mental Health Information Management

Below is a complete listing of all current MHIM Forms.
If you would like to reference Adminstrative or Clinical ONLY, please use the links on the right.

08/10/11

MHIM-0001E_Change of Provider Progress Note: Read More

MHIM-1001E_Record Change (Printed on Salmon Paper): Read More

MHIM-1003E_Request to Alter Mental Health Episode Dates: Read More

MHIM-1004E_ADULT_Mental Health Medical Record Chart Index: Read More

MHIM-1004E_CHILDRENS_Mental Health Medical Record Chart Index: Read More

MHIM-1005E_Consumer Wellness Plan: Read More

MHIM-1005S_Consumer Wellness Plan_Spanish: Read More

MHIM-1006E_Initial Strengths Needs Assessment: Read More

MHIM-1007E_Annual Update_Initial Strengths-Needs Assessment: Read More

MHIM-1008E_Intake-Face Sheet: Read More

MHIM-1008S_Intake-Face Sheet_Spanish: Read More

MHIM-1009E_Admission Data Sheet-Chart Opening Data Sheet: Read More

MHIM-1010E_Discharge Summary: Read More

MHIM-1011E_Diagnosis Revision Form: Read More

MHIM-1013E_Acknowledgment of Informing Materials-Admission Study: Read More

MHIM-1013S_Acknowledgment of Informing Materials-Admission Study_Spanish: Read More

MHIM-1014E_Consent for Treatment Adult: Read More

MHIM-1014S_Consent for Treatment Adult_Spanish: Read More

MHIM-1022E_Admission Paperwork Checklist: Read More

MHIM-1022S_Admission Paperwork Checklist_Spanish: Read More

MHIM-1023E_Appeal Form: Read More

MHIM-1023S_Appeal Form_Spanish: Read More

MHIM-1024E_Authorization for Medical Transport: Read More

MHIM-1028E_Consent To Treatment Minor: Read More

MHIM-1028S_Consent for Treatment Minor_Spanish: Read More

MHIM-1031E_Grievance Form: Read More

MHIM-1031S_Grievance Form_Spanish: Read More

MHIM-1033E_Notice of Health Information Practices: Read More

MHIM-1033S_Notice of Health Information Practices_Spanish: Read More

MHIM-1035E_Physicians Orders: Read More

MHIM-1036E_Primary Care Physician_Referral Form_MHP: Read More

MHIM-1036S_Primary Care Physician_Referral Form_MHP_Spanish: Read More

MHIM-1038E_Mental Health Record: Read More

MHIM-1039E_Mental Health SED Criteria: Read More

MHIM-1040E_TBS Assessment: Read More

MHIM-1041E_TBS Plan of Care: Read More

MHIM-1043E_TBS Progress Note: Read More

MHIM-1044E_TBS Referral Form: Read More

MHIM-1045E_MIT Request For Multidisciplinary Interagency Tx_Attachment A: Read More

MHIM-1046E_MIT Multidisciplinary Interagency Tx_ Attachment B: Read More

MHIM-1047E_Mental Health Flow Sheet: Read More

MHIM-1048E_LOCUS-CALOCUS Worksheet_Adult-Child: Read More

MHIM-1049E_Request for Auth to Place_Adults_To Revise: Read More

MHIM-1050E_Request to Change Provider: Read More

MHIM-1050S_Request to Change Provider_Spanish: Read More

MHIM-1051E_Proof of Use Record_CLNPHRM19: Read More

MHIM-1052E_Placement Orientation-Assessment Referral: Read More

MHIM-1053E_WandR Stipend Payment Request Form: Read More

MHIM-2000E_Coordination of Service Document: Read More

MHIM-2001E_Disallowed Claim Request Form: Read More

MHIM-2002E_Mental Health Forms Request: Read More

MHIM-2003E_MHS Progress Note: Read More

MHIM-2004E_CM-Linkage Progress Note: Read More

MHIM-2005E_MHS Group Progress Note: Read More

MHIM-2006E_Inpatient TAR Review Form: Read More

MHIM-2007E_What Is A Grievance: Read More

MHIM-2007S_What Is A Grievance_Spanish: Read More

MHIM-2008E_What Is An Appeal: Read More

MHIM-2008S_What Is An Appeal_Spanish: Read More

MHIM-2009E_Childrens RISC Referral: Read More

MHIM-2010E_Crisis Intervention Progress Note: Read More

MHIM-2012E_Emergency Contact Information: Read More

MHIM-2013E_Pharmacy Authorization Outpatient Request: Read More

MHIM-2014E_Crisis Intervention Contingency Plan: Read More

MHIM-2015E_Medical Necessity for Adult: Read More

MHIM-2015S_Medical Necessity for Adult_Spanish: Read More

MHIM-2016E_Medical Necessity for Children and Youth: Read More

MHIM-2016S_Medical Necessity for Children and Youth_Spanish: Read More

MHIM-2017E_Pharmacy Authorization Hospital-IMD Request: Read More

MHIM-2018E_Restricted Access Records Request Form: Read More

MHIM-2020E_Consent for Treatment_ITT: Read More

MHIM-2021E_Intensvive Treatment Track_ITT__Intro: Read More

MHIM-2022E_SAL Laser Front and back: Read More

MHIM-2023E_CSS Families: Read More

MHIM-2023S_CSS Families_11-09-10_Spanish: Read More

MHIM-2024E_CSS Consumers 12-Older: Read More

MHIM-2024S_CSS Consumers 12-Older_11-10-10_Spanish: Read More

MHIM-2025E_Release of Mental Health Records_PHI: Read More

MHIM-2027E_Request of Records: Read More