Clinical Forms

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.

• Diagnosis Information Form (Effective 10/1/15)
• Juvenile Justice Transition Aftercare Services (JJTAS) Referral Form
• Lanterman Petris-Short (LPS) 5150-5585 Assessment Form
• Triage
• Assessment
• Client Treatment Plan
• Authorization
• Consent
• Co-Occurring Disorders
• Diagnosis Information
• Progress Note
• Medication Notes
• Juvenile Justice
• Miscellaneous
• Outcome Measures
• Clinical Forms Inventory  (Revised 7/1/19)
• Clinical Form Usage for Initial Contacts with Individuals/Clients
• Referrals & Communication to Other Departments
• Revised Medication Forms and Supplemental TBS Assessment Edition 2012-02
• Standardized Abbreviations List
• Out of County
• Service Request Tracking System (New)
• Service Request Log (Revised 4/19/19)
• NON-DMH Prescriber Credentialing
  
• Katie A Subclass Membership Verification MH 729
• CANS IP MH 735 (effective 7/1/19)
• PSC 35 MH 736 (effective 7/1/19)

Day Treatment/Day Rehab Forms