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Child and Adolescent Psychiatry
Personal Mental Health Care
443-546-5350
Forms
All forms are in pdf, download Adobe Reader Here
Office Forms
Forms 1-7 required for intake:
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1. Fee Schedule
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2. Office Policies
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3. Patient Information
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4. Consent for Treatment
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5. Consent to Participate in Telepsychiatry
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6. Patient Authorization for Release of Information
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7. Medicare Opt-Out Contract (Medicare recipients only)
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8. Psychotherapy Consent
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9. Psychotropic Medication Consent
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10. Notice of Privacy Practice
Rating Scales
ADHD
Depression
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PHQ - 9 Modified for Adolescents (ages 11-17)
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PHQ - 9 Parent Report
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PHQ - 9 Adult
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Depression Scale for Children (ages 6-17)
Anxiety
Mania
OCD
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Yale-Brown Obsessive Compulsive Scale--Parent Report (ages 6-17)
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Obsessive Compulsive Inventory-Child Version
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Obsessive Compulsive Inventory-Adult Version
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Obsessive Compulsive Inventory-Revised Adult
Substance Use
Trauma
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