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C. Mental Health Checklist
Observe at least one mental health exam conducted by a panel physician
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1.
Name of Contractor Completing Survey:
(Required.)
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2.
Open-ended questions are used when discussing mental health history (refer to the psychiatric history interview guide for examples).
(Required.)
True
False
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3.
The exam is conducted in an emphatic and non-judgmental manner.
(Required.)
True
False
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4.
Describe how applicants are screened for substance use disorders during the interview (alcohol and controlled substances).
(Required.)
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5.
Risk to self or others addressed during the interview.
(Required.)
True
False
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6.
Applicants asked about current or prior use of therapy, medication, or hospitalization.
(Required.)
True
False
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7.
Applicants asked about legal trouble or behaviors tied to mental health or substance use.
(Required.)
True
False
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8.
The panel site has clear criteria for mental health specialist referrals.
(Required.)
True
False
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9.
List what the most common reasons for mental health specialist referral are.
(Required.)
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10.
Describe when deferral of mental health classification is used.
(Required.)
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11.
Describe what additional evaluations are taken during deferral periods (e.g., random drug testing, gathering more records, etc.).
(Required.)
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12.
Additional comments on the mental health exam (open comment):
(Required.)