Ohio Department of Mental Health MS Word Forms

SOQIC Standardized Microsoft Word Forms

The SOQIC forms were revised in 2008 by a committee consisting of agency personnel, ADAMH Board staff and other stakeholders. The criteria used to decide what revisions to make to the forms was based on ensuring continued compliance with certification/licensure and accreditation standards, increasing the efficiency of the forms and supporting the clinical quality of the form set.

Instructions to provide guidance about how to complete each of the SOQIC forms can be found in the Forms User Manual/Section Four.

When viewing this information, please note that these standardized forms are only tools for documentation processes. While designed to effectively aid clinical staff in data collection and client assessment and treatment processes, use of these forms alone cannot ensure compliance or effective care.

All of the following forms can not be changed until you unprotect the document. To unprotect the forms complete the following steps:

  • Click on Tools
  • Click on Unprotect Document
  • Enter password: soqic (lower case) and click OK

To protect the forms with a password complete the following steps:

  • Click on Tools
  • Click on Protect Document (forms)
  • Enter password and click OK
  • Reenter the password
  • Click on File and Save

Note: Forms were updated 11/2008. All forms are posted in Microsoft Office Word.

Form Title Form No.
Demographic Information SQ-08-010
Health History Questionnaire SQ-08-020
Crisis Intervention and Assessment Plan SQ-08-030
Adult Diagnostic Assessment SQ-08-040
Adult Diagnostic Assessment Update SQ-08-045
Child/Adolescent Diagnostic Assessment SQ-08-050
Child/Adolescent Diagnostic Assessment Update SQ-08-055
Mental Status Exam (MSE) SQ-08-060
Lethality Assessment SQ-08-070
Initial Psychiatric Evaluation SQ-08-080
Individualized Service Plan SQ-08-090
Individualized Service Plan Review SQ-08-095
Psychiatric/Pharmacological Management Plan SQ-08-100
Pharmacologic Management/Psychiatric Progress Note SQ-08-110
Pharmacologic Management/Nursing Progress Note Long SQ-08-120
Pharmacologic Management/Nursing Progress Note Short SQ-08-125
Individual Progress Note SQ-08-130
Community Psychiatric Supportive Treatment Progress Note Long SQ-08-140
Community Psychiatric Supportive Treatment Progress Note Short SQ-08-145
Group Progress Note SQ-08-150
Partial Hospital Progress Note SQ-08-160
Transfer/Discharge Summary SQ-08-170
ODADAS Level of Care Worksheets