Ohio Department of Mental Health Electronic Forms

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