Template library · Assessments & screeners
General Risk Screen template
Screen for risk factors requiring immediate clinical attention.
Broad screen for immediate safety risks
- 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
Risk Domains Screened
- Suicidal ideation or intentTick box
- Homicidal ideation or intentTick box
- Self-harm behaviorsTick box
- Risk of harm to othersTick box
- Psychosis or impaired reality testingTick box
- Severe intoxication or withdrawalTick box
- Inability to care for basic needsTick box
Clinical Notes
- Details of any endorsed itemsText
- Immediate safety plan / dispositionText
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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