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Med-Legal Intake

This comprehensive checklist will assist you in identifying signs and symptoms of head injuries and mental health issues related to accidents. It is important to refer clients exhibiting these signs to Healthier Minds for a thorough evaluation.

Client Information:
Instructions:
Please review the following checklist and gather information from the client regarding signs and symptoms of head injuries and mental health issues following an accident. Mark the appropriate boxes for each symptom or type of injury reported by the client. This evaluation card will assist Healthier Minds, in understanding the client’s condition and providing the necessary help.
Remember, referring clients promptly will facilitate early intervention and treatment.
Please submit this evaluation info to Healthier Minds for documentation purposes. Thank you for providing the necessary information regarding the client’s condition after the accident.

Checklist

This checklist will help you better identify signs and symptoms of a head injury and/or mental health issues surrounding an accident.

Who to Refer?

Head Injury

Clients who experience one or more of the signs or symptoms after a bump, blow, or jolt to the head or neck is recommended for an evaluation with Healthier Minds.

Mental Health

Clients experiencing any change in their mood, anxiety levels, or significant life changes after a traumatic incident are recommended for an evaluation with Healthier Minds.

When to Refer?

The sooner Clients are referred, the sooner treatment can begin.
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If you are experiencing a life-threatening emergency, please call 911 or use these resources to get immediate help.‍

 
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