Omh.ny.govomhwebguidanceCOVID-19 SCREENING FORM - New York State Office of Mental ... 2026

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Definition and Purpose of the COVID-19 Screening Form

The COVID-19 Screening Form from the New York State Office of Mental Health (OMH) serves a vital role in ensuring the safety and well-being of individuals entering psychiatric centers. This form is designed to assess the COVID-19 status of patients, covering critical areas such as symptoms, recent COVID-19 tests, and vaccination status. The primary objective of this form is to determine the appropriateness of admitting or readmitting individuals to mental health facilities, with the ultimate goal of preventing the spread of COVID-19 within these environments.

How to Use the COVID-19 Screening Form

To effectively use the COVID-19 Screening Form, begin by ensuring that all sections of the form are filled out accurately. Patients or their guardians should provide honest and up-to-date information about any symptoms, exposure to COVID-19, recent test results, and vaccination details. Staff at psychiatric centers utilize this information to assess risk levels and decide on the necessary precautions before entry into the facility. It’s essential that any updates to health status be promptly communicated to the designated personnel to maintain safety protocols.

How to Obtain the COVID-19 Screening Form

The COVID-19 Screening Form can be accessed through the New York State OMH website or directly from psychiatric centers. Beneficiaries or responsible healthcare providers can download the form online, which can then be printed or filled out digitally. Some facilities may also provide the form upon arrival; however, it is advisable to complete it in advance to expedite the admission process.

Steps to Complete the Form

  1. Gather Personal Information

    • Fill in the patient's full name, contact information, and identification details.
  2. Complete the Health Questionnaire

    • Indicate any symptoms related to COVID-19, such as a cough, fever, or loss of taste and smell.
  3. Document Recent COVID-19 Test Results

    • Include the date of the most recent COVID-19 test and the result if available.
  4. Vaccination Status

    • Provide information regarding COVID-19 vaccination, including dates and type of vaccine received.
  5. Review and Submit

    • Carefully review all provided information for accuracy and then submit the form through the specified channel, whether that be online, via email, or in person.

Importance of Using the Form

The utilization of this form is critical for managing health risks related to COVID-19 in psychiatric centers. It assists in identifying potential COVID-19 cases early, reduces transmission within the institution, and helps in the implementation of appropriate health measures. Accurately filled forms support healthcare providers in making informed decisions about patient care and facility operations.

Typical Users of the Form

The COVID-19 Screening Form is predominantly used by patients seeking admission or readmission to New York State OMH psychiatric centers. Healthcare providers, administrative staff, and caregivers may also be involved in completing or facilitating the completion of the form to ensure compliance with health and safety regulations.

Key Elements of the Form

  • Symptom Assessment: Questions designed to capture the presence of COVID-19 symptoms.
  • Test Results: Section for recording recent COVID-19 test outcomes.
  • Vaccination Details: Fields to document the receipt and specifics of COVID-19 vaccinations.
  • Contact Information: Space to provide necessary personal and emergency contact information.

State-Specific Guidelines

New York State has established specific protocols regarding the admission process to mental health facilities, especially under pandemic conditions. These include mandatory health screenings like the COVID-19 Screening Form. Adhering to state guidelines ensures that psychiatric centers operate safely and effectively while mitigating the risks associated with COVID-19.

Examples and Scenarios

Consider a scenario where a patient previously admitted to a psychiatric center must return for continued care. By using the COVID-19 Screening Form, the center can make informed decisions about the patient's return, implementing necessary quarantine protocols if the form indicates a recent exposure or symptoms. Similarly, new admissions can be assessed to determine the safest integration into the facility's environment.

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Under the law you have the right to be treated confidentially, with respect and dignity by all staff people. Treatment or access to programs may not be limited or denied because of race, creed, color, sex, national origin, age, marital status, or disabilities which are unrelated to treatment.
A community mental health team (CMHT) can support you to recover from mental health issues. They can give you short or long-term care and treatment if you are in the community. Health professionals from different backgrounds work in the CMHT. They work together to help you get better.
The Office of Mental Health (OMH) operates psychiatric centers across the State. OMH also regulates, certifies and oversees more than 4,500 programs, operated by local governments and nonprofit agencies.
2025-S2033 (ACTIVE) - Summary Requires parity in the mental and physical health treatment of the residents of New York state; provides that both mental and physical health will be matters of public concern and provision therefor shall be made by the state and by such of its subdivisions.

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