Clinical Forms-Outcome Measures

Outcome Measures

The Los Angeles County Department of Mental Health provides these forms for use by mental health providers employed by the Department and those under contract with the Department.

Outcome Measures Forms

  • Outcomes Measures Application Form Field Capable Clinical Services – MH 662
  • Outcome Measures Application Form FCCS: 2nd Year and Later – MH 663
  • Outcome Measures Application Child Baseline Age Group: 0-15 – MH-682 (Effective 8/12/16)
  • Outcome Measures Application Child Key Event Change (KEC) Age Group: 0-15 – MH-683 (Effective 8/12/16)
  • Outcome Measures Application Child 3-Month (3M) Age Group: 0-15 – MH-684
    (Effective 8/12/16)
  • Outcome Measures Application Transitional Age Youth (TAY) Baseline Age Group: 16-25 –
    MH-685 (Effective 8/12/16)
  • Outcome Measures Application Transitional Age Youth (TAY) Key Event Change (KEC) Age Group: 16-25 – MH-686 (Effective 8/12/16)
  • Outcome Measures Application Transitional Age Youth (TAY) 3-Month (3M) Age Group: 16-25 – MH-687 (Effective 8/12/16)
  • Outcome Measures Application Adult Baseline Age Group: 26-59 – MH-688 (Effective 8/12/16)
  • Outcome Measures Application Adult Key Event Change (KEC) Age Group: 26-59 – MH-689 (Effective 8/12/16)
  • Outcome Measures Application Adult 3-Month (3M) Age Group: 26-59 – MH-690
    (Effective 8/12/16)
  • Outcome Measures Application Older Adult Baseline Age Group: 60+ – MH-691
    (Effective 8/12/16)
  • Outcome Measures Application Older Adult Key Event Change (KEC) Age Group: 60+ – MH-692 (Effective 8/12/16)
  • Outcome Measures Application Older Adult 3-Month (3M) Age Group: 60+ – MH-693
    (Effective 8/12/16)

Related Information