Welcome to the Resources for Blueprint Clinicians Page!
We are so excited that you have chosen to participate in this exciting program with the goal of making mental health services more accessible to our community via our primary care offices! As this is an evolving part of the VCR practice this page will be growing as we learn and develop more.
Paperwork
Note you will need to make a copy of any Google Document before you can edit.
Informed Consent for Treatment- Clinician must personalize with name, credentials, and office contact information in heading.
Blueprint Specific Progress Note- Clinician must personalize with name, credentials, and office contact information in heading.
Information about my practice- Clinician must personalize with name, credentials, and office contact information in heading.
Privacy Practices Signature Page -Clinician must personalize with name, credentials, and office contact information in heading.
Release of Information- Clinician must personalize with name, credentials, and office contact information in heading.
Telehealth Consent Form- Clinician must personalize with name, credentials, and office contact information in heading.
Discharge Summary- Clinician must personalize with name, credentials, and office contact information in heading.
Don’t forget to also include your own professional disclosure document.
Village Health Specific Versions
Information about my practice- docx
Discharge Summary- docx
Referral Resources
Google Spreadsheet-Referral Resources
Additional Resources
Referral Tracking Spreadsheet- Clinician must personalize with name, credentials, and office contact information in heading.
CHT Unique Encounter Collection Data- PDF