PPS and IO: Mobile Notes - Clinical Questionnaires

This article applies to Valant IO and the Private Practice Suite

Clinical Questionnaires allow you to assign sections of your note to the patient (via Patient Portal), which you can then review with the patient in session.

There are three kinds of Clinical Questionnaire (Expand):

Clinical History Form (CHF)

  • The CHF contains 16 of the sections of the Intake Note
  • Designed to be assigned pre-intake to the patient (via Patient Portal) if you will be using either the Intake Note or the Child Intake Note
  • Can be assigned as a one-time measure on the Measures tab in EMR
  • After the patient submits it, start your Intake Note or Child Intake Note, and the data will pre-populate the appropriate sections
  • If for any reason you don't want these data to be pulled into your Intake Note or Child Intake Note, simply "ignore" the CHF on the "Template Details" page when starting your note
  • The 16 sections are: Stressors; Substance History: Substances used, Treatment History, and Consequences of Substance Abuse; Past Psychiatric History: Inpatient, Outpatient, Suicide/Self Harm, and Violence; Past Medical History; Psychiatric Medicine History; Patient Allergies; Family Psychiatric History; Social History: Developmental & Educational, General, and Menstruation & Pregnancy; and Review of Systems


Interim Clinical History (ICH)

  • The ICH contains 3 sections of the Psychiatric Progress Note
  • Designed to be assigned on a repeated basis, post-intake, to the patient (via Patient Portal) if you will be using the Psychiatric Progress Note
  • Can be assigned as a scheduled measure or a one-time measure on the Measures tab in EMR
  • After the patient submits it, start your Psychiatric Progress Note, and the data will overwrite/pre-populate the appropriate sections
  • If for any reason you don't want these data to be pulled into your Psychiatric Progress Note, simply "ignore" the ICH on the "Template Details" page when starting your note.
  • The 3 sections are: Stressors; Side Effects; and Review of Systems


MFT Clinical History Form (MFT CHF)

  • Designed in partnership with and endorsed by the American Association for Marriage and Family Therapy (AAMFT)
  • The MFT CHF contains 18 of the sections of the Marriage and Family Therapy Intake Note
  • Designed to be assigned pre-intake to the patient (via Patient Portal) if you will be using the Marriage and Family Therapy Intake Note
  • Can be assigned as a one-time measure on the Measures tab in EMR
  • After the patient submits it, start your Marriage and Family Therapy Intake Note, and the data will pre-populate the appropriate sections
  • If for any reason you don't want these data to be pulled into your Marriage and Family Therapy Intake Note, simply "ignore" the MFT CHF on the "Template Details" page when starting your note
  • The 18 sections are: Referral; Relationship Information; Presenting Problem - Intake; Family of Origin History; Substance Abuse Hx; Substance Treatment Hx; Substance Use Consequences; Inpatient Hx; Outpatient Hx; Suicide/Self-Harm Hx; Violence Hx; Past Medical Hx; Psychiatric Med Hx; Developmental and Educational Hx; General Social Hx; Menstruation and Pregnancy Hx; Family Background; External Systems


Comprehensive Child Clinical History Form (CC CHF)

  • The CC CHF contains 21 of the sections of the Child Intake Note - Comprehensive
  • Designed to be assigned pre-intake to the patient (via Patient Portal) if you will be using the Child Intake Note - Comprehensive
  • Can be assigned as a one-time measure on the Measures tab in EMR
  • After the patient submits it, start your Child Intake Note - Comprehensive, and the data will pre-populate the appropriate sections
  • If for any reason you don't want these data to be pulled into your Child Intake Note - Comprehensive, simply "ignore" the CC CHF on the "Template Details" page when starting your note
  • The 20 sections are: Introductory Information; Chief Complaint; Current Behavior; Review of Systems; Mental Health Treatment/Evaluation History; Psychiatric Medication History; Medical History; Social History - Menstruation & Pregnancy; Family Mental Health/Social History; Family Medical History; Prenatal Development and Birth History; Developmental History; Current Living Situation; Family Relationships; Educational History; Social History; Lifestyle Health; Legal History; Trauma/Stressors; Spiritual Orientation; Caregiver Comments


Downloads

Clinical History Form.pdf

Interim Clinical History.pdf

MFT Clinical History Format.pdf

Child Clinical History Form.pdf

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