Forms Available on bhworks
Modified on Thu, 9 Jan at 2:13 PM
bhworks has a large library of forms, assessments, and screeners that can be completed electronically on the platform. These include forms that can be completed by staff, participants, parents/guardians, and teachers.
The document linked below provides a list of all forms currently available and their respective use or domain. If you would like access to any of these tools, please contact support@mdlogix.com for assistance.
For an additional cost, mdlogix can also create custom forms for you organization. To get a quote, please email support@mdlogix.com with a copy of the form that you would like for a quote. Depending on the licensure, some forms cannot be created on bhworks due to copyright or licensing requirements.
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| Form Name | Domain / Application |
| BEHAVIORAL HEALTH SCREEN VERSIONS | |
| Behavioral Health Screen - Adult | Multi-Domain |
| Behavioral Health Screen - PC 12 to 24 | Multi-Domain |
| Behavioral Health Screen - PC 25 and above | Multi-Domain |
| Behavioral Health Screen - School 12 to 24 | Multi-Domain |
| Behavioral Health Screen - SD SUB PHQ | Social Determinants of Health, Substance, Depression |
| Behavioral Health Screen for Ages 6-14 (Parent Report) | Multi-Domain |
| BH-Workplace | Multi-Domain Employee Assistance Program (EAP) |
| Comprehensive Universal Behavioral Health Screen (CUBS) | Multi-Domain including SDOH (Adults) |
| Behavioral Health Screen - 3rd Party Report | Multi-Domain |
| Behavioral Health Screen - Mobile Crisis | Multi-Domain |
| Telehealth Behavioral Health Screen | Multi- Domain |
| Employee Behavioral Health Screen | Multi-Domain Employee Assistance Program (EAP) |
| ACADEMICS | |
| Academic Plan | Academic Improvement |
| College Readiness | Secondary Education Preparedness |
| ALCOHOL USE DISORDER | |
| Alcohol Use Disorders Identification Test (AUDIT) | Alcohol |
| Alcohol Use Disorders Identification Test (AUDIT-C) | Alcohol |
| ANXIETY | |
| Carroll-Davidson Generalized Anxiety Disorder (CDGAD) | Anxiety |
| Generalized Anxiety Disorder (GAD 7) | Anxiety |
| Generalized Anxiety Disorder (GAD-C 11-17) | Anxiety |
| Hamilton Anxiety Rating Scale (HAM-A) | Anxiety including Somatic Symptoms |
| Screen for Child Anxiety Related Disorders (SCARED) - Child Report | Anxiety |
| Screen for Child Anxiety Related Disorders (SCARED) - Parent Report | Anxiety |
| Classroom Behaviors | |
| Student Risk Screening Scale - Internalizing and Externalizing (SRSS-IE) MS/HS | Internalizing and Externalizing Behaviors |
| Student Risk Screening Scale - Internalizing and Externalizing (SRSS-IE) Elementary | Internalizing and Externalizing Behaviors |
| Student Risk Screening Scale - Internalizing and Externalizing (SRSS-IE) Early Childhood | Internalizing and Externalizing Behaviors |
| Teacher Observation of Classroom Adaptation – Checklist (TOCA-C) | Social–emotional, behavioral, and family |
| CONSENT DOCUMENTATION | |
| Informed Consent | Services and Medicaid Billing Consent |
| Consent for 3rd Party Billing | Consent to Share Information |
| Release of Information | Consent to Release Information |
| Release and Disclosure of Information | Consent to Release and Receive Information |
| Consent for Screening | Consent to Screen |
| Consent for Supervision | Consent for Limited License Staff |
| Consent for Community Referral | Consent for External Referrals |
| HIPAA Acknowledgement | HIPAA Disclosure |
| CRISIS INTERVENTION | |
| Crisis Support Response Plan | Patient Risk Safety Plan |
| Crisis Response Log | Crisis Referral Information and Outcomes |
| DEPRESSION | |
| Patient Health Questionnaire (PHQ) | Depression |
| Patient Health Questionnaire Adolescent (PHQ-A) | Depression |
| Geriatric Depression Scale - Short Form | Depression |
| Hamilton Depression Rating Scale | Depression |
| PROMIS Depression Short-Form | Depression |
| Short Mood & Feelings Questionnaire - Self-Report | Depression |
| Short Mood & Feelings Questionnaire - Parent Report | Depression |
| EMPLOYERS | |
| Employee Engagement | Employee Assistance Program |
| New Employee Forms | Employee Onboarding |
| Company Culture Survey | Workplace Survey (EAP) |
| FAMILY & RELATIONSHIPS | |
| Experience in Close Relationships | Family Support & Relationships |
| GRANT REPORTING - STATE & FEDERAL | |
| GPRA Intake | Government Performance and Results Act (SAMHSA) |
| GPRA Mid-Treatment | Government Performance and Results Act (SAMHSA) |
| GPRA Discharge | Government Performance and Results Act (SAMHSA) |
| NOMS Baseline Interview - Adult | National Outcomes Measures |
| NOMS Reassessment Interview - Adult | National Outcomes Measures |
| NOMS Discharge Interview - Adult | National Outcomes Measures |
| NOMS Baseline Interview - Child | National Outcomes Measures |
| NOMS Reassessment Interview - Child | National Outcomes Measures |
| NOMS Discharge Interview - Child | National Outcomes Measures |
| Student Assistance Program File 2.0 (JQRS) | Grant Reporting for Student Assistance Program |
| MEDICAL/MENTAL HEALTH HISTORY & DEVELOPMENT | |
| Childhood History Questionnaire | Developmental History and Background |
| Checklist for Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure | Early Childhood History & Development |
| Medical History Questionnaire | Intake / Medical History |
| Client Service Plan | Medical & Mental Health History, Clinical Observation, Treatment Plan |
| MENTAL / PHYSICAL IMPAIRMENT | |
| Functional Assessment Form | Mental / Physical Impairment |
| MULTI-DOMAIN ASSESSMENTS - CHILD & ADOLESCENTS | |
| Child and Adolescent Needs and Strengths (CANS) | Multi-Domain Clinical Observation |
| Pediatric Symptoms Checklist 35 (Youth Report) | Multi-Domain |
| Pediatric Symptoms Checklist 35 (Parent Report) | Multi-Domain |
| Pediatric Symptoms Checklist 17 (Parent Report) | Multi-Domain |
| HEADS-ED (Home, Education, Activities, Drugs, Suicidality, Emotions, Discharge) | Multi-Domain |
| ORGANIZATIONAL READINESS & DEPLOYMENT | |
| Facility Contact & Recruitment Tracking | Organizational Deployment |
| Facility Go Live Checklist | Organizational Deployment Checklist |
| Facility Readiness Questionnaire | Organizational Readiness |
| Equipment Info | Facility Equipment Tracking |
| PAIN | |
| Defense and Veterans Pain Rating Scale (DVPRS) | Chronic Pain |
| Pain Intensity - Short Form | Pain |
| REHABILITATION TREATMENT | |
| Outpatient Intake - Adolescent | Multi-Domain Rehabilitation |
| Outpatient Intake - Young Adult | Multi-Domain Rehabilitation |
| Outpatient Mid-Treatment - Adolescent | Multi-Domain Rehabilitation |
| Outpatient Mid-Treatment - Young Adult | Multi-Domain Rehabilitation |
| Residential Intake – Adolescent | Multi-Domain Rehabilitation |
| Residential Intake – Young Adult | Multi-Domain Rehabilitation |
| Residential Mid-Treatment – Adolescent | Multi-Domain Rehabilitation |
| Residential Mid-Treatment – Young Adult | Multi-Domain Rehabilitation |
| Family Feedback | Rehabilitation Feedback |
| Patient Feedback | Rehabilitation Feedback |
| SEXUAL TRANSMITTED INFECTIONS | |
| HIV/AIDS Risk Assessment Tool | STI Risk Assessment |
| Sexual Health Survey | STI Risk Assessment |
| STD/HIV Risk Screening & Intervention Tool | STI Risk Assessment |
| SLEEP / INSOMNIA | |
| Insomnia Severity Index | Insomnia / Sleep Problems |
| Pittsburgh Sleep Quality Index | Sleep |
| SOCIAL EMOTIONAL LEARNING | |
| Social Emotional Competency Assessment (Short) | Social Emotional Learning |
| Social Emotional Competency Assessment (Long) | Social Emotional Learning |
| SOCIAL DETERMINANTS OF HEALTH | |
| Social Determinants Questionnaire | Social Determinants of Health |
| Social Determinants Questionnaire Child | Social Determinants of Health |
| SEDH Screening Tool | Social Environmental Determinants of Health |
| STRESS | |
| Perceived Stress Scale | Stress |
| STUDENT MENTAL HEALTH SUPPORT | |
| Biopsychosocial Assessment (BPSA) | Biopsychosocial Assessment |
| Plan of Care | Student Treatment Planning |
| Academic Plan | Academic Improvement |
| Functional Behavior Assessment | Behavior Assessment |
| Student Assistance Program Tracking Form | Student Counseling |
| Student Engagement Notes | Student Counseling |
| Discharge Summary | Therapy Discharge |
| STUDENT 504 DOCUMENTS | |
| Section 504 - Referral Form | Section 504 |
| Section 504 - Evaluation/Placement Checklist | Section 504 |
| Section 504 - Evaluation Consent | Section 504 |
| Section 504 - Parent Input | Section 504 |
| Section 504 - Eligibility Determination Report | Section 504 |
| Section 504 - Plan | Section 504 |
| Section 504 - Prior Written Notice | Section 504 |
| Section 504 - Manifestation Determination | Section 504 |
| SUBSTANCE USE INCLUDING ALCOHOL AND TOBACCO | |
| Brief Addiction Monitor-Revised (BAM-R) | Substance Use |
| Drug Abuse Screening Test (DAST-10) | Substance Use |
| Simple Screen for Substance Abuse | Substance Use |
| CAGE-AID | Substance Use including Alcohol |
| NIDA Quick Screen | Substance Use - Adults |
| NIDA-Modified ASSIST | Substance Use - Adults |
| Addiction Severity Index-5th Edition | Substance Use Addiction |
| Clinical Opiate Withdrawal Scale (COWS) | Substance Use Rehabilitation |
| CRAFFT 2.1 | Substance-related Risks (Adolescents) |
| CRAFFT 2.1N | Substance-related Risks including Vaping (Adolescents) |
| Chemical Dependency Evaluation | Substance Use |
| Overdose Questionnaire | Rehabilitation Intake |
| Penn State Electronic Cigarette Dependence Index | Tobacco Use |
| Penn State Cigarette Dependence Index | Tobacco Use |
| The Tobacco, Alcohol, Prescription medications, and other Substance (TAPS) Tool | Substance Use including Nicotine |
| Treatment Effectiveness Assessment (TEA) | Treatment Monitoring |
| SUICIDE IDEATION | |
| Ask Suicide Questions (ASQ) | Suicide Ideation |
| Columbia-SSRS-ED Clinician Report | Suicide Ideation - Clinician Report |
| Columbia-SSRS-ED | Suicide Ideation - Patient Self-Report |
| Safety Plan Template | Suicide Risk Treatment Plan |
| Summer Safety Plan | Suicide Ideation Management |
| CAMS Therapeutic Worksheet | Suicide Treatment Plan |
| CAMS SSF4 Initial Session | Suicide Treatment Plan |
| CAMS SSF4 Interim Session | Suicide Treatment Plan |
| CAMS SSF4 Final Session | Suicide Treatment Plan |
| TRAUMA | |
| ACEs Adverse Childhood Experiences | Traumatic Experiences |
| ACEs for Adults | Traumatic Experiences |
| ACE-Q Child Parent Report(ACE-Q) Child | Traumatic Experiences |
| ACE-Q Teen Self-Report | Traumatic Experiences |
| ACEs Positive Childhood Experiences | Traumatic Experiences |
| ACEs: Resilience | Traumatic Experiences |
| Child and Adolescent Trauma Screening (CATS) | Traumatic Experiences |
| Life Events Checklist (LEC-5E) for DSM-5 | Personal / Environmental Trauma |
| USABILITY & UTILITY | |
| BHS in Schools Usability Survey | Project / Organization Readiness |
| Usability and Utility Questionnaire | Software Focus Groups |
| WELL BEING | |
| WHO (Five) Well-Being Index | Well-Being |
| PCL-C | Emotional / Well-Being |
| Self Report Quality of Life | Quality of Life |
| ASSESSMENT BATTERIES | |
| PHQ-AuditC-GAD | Depression, Alcohol, and Anxiety |
| PHQ-GAD | Depression and Anxiety |
| PHQ-GAD Adolescents | Depression and Anxiety |
| PHQA-CRAFFT | Depression and Alcohol/Substance Use |
| PHQ-AuditC | Depression and Alcohol |
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