Adult Mental Health Screening

1320 South Frontage Road, Suite 200  Hastings, MN  55033-2481
651-500-0905   651-437-2616 fax

Adult Mental Health Screening

Electronic Communication Consent Acknowledgment:    

Client Name:  
Client Date of Birth:


I attest that I have completed the following electronic screening tools on this date:  CAGE, Patient Health Questionnaire (PHQ-9) & Generalized Anxiety Disorder (GAD-7). The answers to these screening tools were provided by me and represent my state of mind at the time the screening tools were administered. 

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Document name: Adult Mental Health Screening
lock iconUnique Document ID: cfc7b55f8158a4f101412404d85335af2e94fc45
Timestamp Audit
April 15, 2020 8:17 pm CDTAdult Mental Health Screening Uploaded by Anne Hewitt - IP
April 16, 2020 3:09 pm CDT Document owner has handed over this document to 2020-04-16 15:09:35 -