Template library · Assessments & screeners
Crisis Screening template
Rapid screen to determine if the client requires an immediate crisis-level response.
Rapid triage for acute mental health crisis
- 17 fields across 4 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Crisis Indicators
- Current suicidal ideationTick box
- Access to means of self-harmTick box
- Recent suicide attemptTick box
- Active psychosis symptomsTick box
- Substance intoxicationTick box
- Extreme agitation or aggressionTick box
- Unable to ensure own safetyTick box
Immediate Action
- Disposition / level of care recommendedText
- Immediate safety planText
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
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