Form MH #690 2026

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4.3 out of 5

305 votes

The document is the Outcomes Measures Application Form (Form MH #690) used by the Los Angeles County Department of Mental Health for assessing adult clients aged 26-59. It collects administrative information, financial support sources, physical health status, and legal custody details related to substance abuse. The form ensures compliance with state and federal privacy laws.

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Click ‘Get Form’ to open Form MH #690 in the editor.
Begin by filling out the Administrative Information section. Enter the Client ID, Date of Birth, Episode ID, Provider Number, and both the Last and First Name of the client. Additionally, include the Partnership Date and Assessment Date.
In the Financial section, indicate all sources of financial support applicable to the client by checking the relevant boxes. Options include wages, savings, benefits, and assistance programs.
Proceed to the Physical Health section. For each question regarding health status and access to medical services, select 'Yes' or 'No' based on the client's situation.
Finally, complete the Custody Information section by entering the total number of children in various custody statuses as required.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (46 Votes)
2010	4.3 Satisfied (305 Votes)

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