Patient Forms

Staying Health Assessment

The Staying Healthy Assessment (SHA) will be completed for all Medi-Cal managed care patients within 120 days of enrollment as part of their Initial Health Assessment. The assessment will provide dialogue between the provider and patient, identify health education needs, and identify potential interventions, referrals and follow up. This is a Department of Health Care Services requirement for all Medi-Cal providers. Completing this form is voluntary but it will help your doctor understand your health needs. Forms range by age, please print and complete the appropriate form and turn it in the day of your appointment.