SOQIC Standardized Electronic Forms
The SOQIC e-forms have been developed using IBM® Workplace Forms™ Designer software and are provided to agencies at no cost. Each form includes the IBM® Workplace Forms™ Viewer, which enables the use of the form. Each form is individually licensed so that anyone can use them. The electronic forms (e-forms) can be downloaded, completed and saved in a user designated location on the user's computer or system. While the electronic forms have a different look, they are, with few exceptions, identical to the paper based forms.
SYSTEM REQUIREMENTS:
Please note: To comply with HIPPA guidelines and to limit agency liability, operating systems must be supported by the manufacturers' security updates when used with personal health information. Therefore, the Ohio Department of Mental Health (ODMH) cannot support an operating system not supported by the manufacturer (e.g. Microsoft '98 and Windows NT).
| Operating systems supported:
Windows 2000 sp2, sp3, sp4
Windows XP sp1, sp2 |
Hardware requirements:
Processor - 500Mhz
Ram - 256 MB Disk Space - 200 MB Resolution - 800 X 600 in 16 bit color |
Web Browsers supported:
Internet Explorer 5.5 sp2, 6 sp1
Netscape 7, 7.1, 7.2 Mozilla 1.7 |
Please contact Dana Harlow with questions regarding form usage.
| E-Forms User Instructions - Please read before opening the forms! | |
| IBM® Workplace Forms™ Viewer Instructions | |
| Download the IBM® Workplace Forms™ Viewer | |
| Form Title | Form No. |
| Demographic Information | SQ-06-010 |
| Health History Questionnaire | SQ-06-020 |
| Crisis Intervention Assessment and Plan | SQ-06-030 |
| Adult Diagnostic Assessment | SQ-06-040 |
| Adult Diagnostic Assessment Update | SQ-06-045 |
| Child/Adolescent Diagnostic Assessment | SQ-06-050 |
| Child/Adolescent Diagnostic Assessment Update | SQ-06-055 |
| Mental Status Exam (MSE) | SQ-06-060 |
| Lethality Assessment | SQ-06-070 |
| Initial Psychiatric Evaluation | SQ-06-080 |
| Individualized Service Plan | SQ-06-090 |
| Individualized Service Plan Review | SQ-06-095 |
| Psychiatric/Pharmacological Management Plan | SQ-06-100 |
| Medical Somatic/Psychiatric Progress Note | SQ-06-110 |
| Medical Somatic/Nursing Progress Note | SQ-06-120 |
| Individual Progress Note | SQ-06-130 |
| Community Psychiatric Supportive Treatment Progress Note | SQ-06-140 |
| Group Progress Note | SQ-06-150 |
| Partial Hospital Progress Note | SQ-06-160 |
| Transfer/Discharge Summary | SQ-06-170 |
