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Md mental health questionnaire

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The document is a Mental Health Questionnaire from the Maryland Healthy Kids Program designed for children aged 13 to 20. It includes a series of questions aimed at assessing mental health issues, behavioral problems, and potential risks related to substance use, social interactions, and family stressors. The form can be completed by the patient, parent/guardian, or healthcare provider and is intended for use in mental health referrals.

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Click ‘Get Form’ to open the Price Smith Doc Template in our editor.
Begin by entering the date at the top of the form, followed by the child's name and date of birth. Ensure accuracy as this information is crucial for identification.
Fill in the Managed Care Organization and Child’s Medicaid number in the designated fields. This helps streamline processing with healthcare providers.
Proceed to check all applicable answers for each question regarding mental health concerns. Use 'Yes' or 'No' options clearly marked next to each question.
If there are any specific concerns or additional notes, utilize the provided spaces to elaborate on those issues, ensuring comprehensive communication.
Finally, have a provider sign and date the form at the bottom. This validates the questionnaire and ensures it is ready for submission.

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Versions	Form popularity	Fillable & printable
2014	4.2 Satisfied (29 Votes)
2010	4 Satisfied (54 Votes)
2006	4 Satisfied (54 Votes)

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