Medical
Mental Health Triage Assessment Form
🧠

Mental Health Triage Assessment Form

1
Collect patient details
2
Verify patient identity
3
Conduct a brief mental health history
4
Conduct a risk assessment
5
Evaluate patient's current mental state
6
Evalute patient's physical health history
7
Determine patient's support system
8
Assess patient's level of distress
9
Evaluate significant life changes or stressors
10
Identify presence of suicidal or homicidal thoughts
11
Conduct substance and alcohol misuse screen
12
Document findings
13
Approval: Clinician
14
Assign patient to appropriate level of care
15
Communicate assessment findings to relevant healthcare team
16
If required, refer patient to specialist resources
17
Develop and discuss follow-up plan with patient
18
Confidentially store the completed Mental Health Triage Assessment form
19
Sign and date the assessment form
20
Close and archive patient's file

Choose which optional cookies to allow. You can change or withdraw consent here at any time.