Clinical Questionnaires allow you to assign sections of your note to the patient (via MYIO), which you can then review with the patient in session.
There are five kinds of Clinical Questionnaires (click on title to see more information for each):
Clinical History Form (CHF)
- The CHF contains 16 of the sections of the Intake Note
- Designed to be assigned pre-intake to the patient (via MYIO) if you will be using either the Intake Note or the Child Intake Note
- Can be assigned as a one-time measure on the Measures tab in IO
- After the patient submits it, start your Intake Note or Child Intake Note, and the data will pre-populate the appropriate sections
- If for any reason you don't want these data to be pulled into your Intake Note or Child Intake Note, simply "ignore" the CHF on the "Template Details" page when starting your note
- The 16 sections are: Stressors; Substance History: Substances used, Treatment History, and Consequences of Substance Abuse; Past Psychiatric History: Inpatient, Outpatient, Suicide/Self Harm, and Violence; Past Medical History; Psychiatric Medication History; Patient Allergies; Family Psychiatric History; Social History: Developmental & Educational, General, and Menstruation & Pregnancy; and Review of Systems
Clinical History Form 2 (CHF2) - Contains No Pregnancy or Abortion Questions in the Patient Portal
When US abortion laws changed, some Valant users expressed concern that the global Clinical History Form includes pregnancy and abortion questions that patients might feel compelled to answer, putting them and their clinicians at risk by having this information documented and stored.
In response, Valant added an alternative Clinical History Form, internally labeled "Clinical History Form 2 (Contains no pregnancy or abortion questions in Patient Portal)". In this form, the following four questions DO NOT appear in the Patient Portal but DO appear in Mobile Notes for the provider to fill out if they desire.
- Have you ever been pregnant?
- Have you ever given birth?
- Have you had any miscarriages?
- Have you had any abortions?
If the clinician leaves these questions blank, they will not appear in the final note.
In order to use the Clinical History Form 2 instead of the original global Clinical History Form, select the alternate version when you are assigning it to the client as a one-time measure.
Interim Clinical History (ICH)
- The ICH contains 3 sections of the Psychiatric Progress Note
- Designed to be assigned on a repeated basis, post-intake, to the patient (via MYIO) if you will be using the Psychiatric Progress Note
- Can be assigned as a scheduled measure or a one-time measure on the Measures tab in IO
- After the patient submits it, start your Psychiatric Progress Note, and the data will overwrite/pre-populate the appropriate sections
- If for any reason you don't want these data to be pulled into your Psychiatric Progress Note, simply "ignore" the ICH on the "Template Details" page when starting your note.
- The 3 sections are: Stressors; Side Effects; and Review of Systems
MFT Clinical History Form (MFT CHF)
- Designed in partnership with and endorsed by the American Association for Marriage and Family Therapy (AAMFT)
- The MFT CHF contains 18 of the sections of the Marriage and Family Therapy Intake Note
- Designed to be assigned pre-intake to the patient (via MYIO) if you will be using the Marriage and Family Therapy Intake Note
- Can be assigned as a one-time measure on the Measures tab in IO
- After the patient submits it, start your Marriage and Family Therapy Intake Note, and the data will pre-populate the appropriate sections
- If for any reason you don't want these data to be pulled into your Marriage and Family Therapy Intake Note, simply "ignore" the MFT CHF on the "Template Details" page when starting your note
- The 18 sections are: Referral; Relationship Information; Presenting Problem - Intake; Family of Origin History; Substance Use Hx; Substance Treatment Hx; Substance Use Consequences; Inpatient Hx; Outpatient Hx; Suicide/Self-Harm Hx; Violence Hx; Past Medical Hx; Psychiatric Med Hx; Developmental and Educational Hx; General Social Hx; Menstruation and Pregnancy Hx; Family Background; External Systems
Comprehensive Child Clinical History Form (CC CHF)
- The CC CHF contains 21 of the sections of the Child Intake Note - Comprehensive
- Designed to be assigned pre-intake to the patient (via MYIO) if you will be using the Child Intake Note - Comprehensive
- Can be assigned as a one-time measure on the Measures tab in IO
- After the patient submits it, start your Child Intake Note - Comprehensive, and the data will pre-populate the appropriate sections
- If for any reason you don't want these data to be pulled into your Child Intake Note - Comprehensive, simply "ignore" the CC CHF on the "Template Details" page when starting your note
- The 21 sections are: Introductory Information; Chief Complaint; Current Behavior; Review of Systems; Mental Health Treatment/Evaluation History; Psychiatric Medication History; Medical History; Social History - Menstruation & Pregnancy; Family Mental Health/Social History; Family Medical History; Prenatal Development and Birth History; Developmental History; Current Living Situation; Family Relationships; Educational History; Social History; Lifestyle Health; Legal History; Trauma/Stressors; Spiritual Orientation; Caregiver Comments
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