VA Mental Health Review

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PHI and HIPAA Compliance Statement

This form was created by Pathfinders, not Optum Serve (formerly called LHI) or the VA. The content of this questionnaire is Protected Health Information (PHI) and subject to HIPAA law. As required by HIPAA law, Pathfinders has a signed Business Associate Agreement (BAA) with Google. Google Forms adheres to the same robust privacy commitments and data protections as the rest of Google Cloud’s enterprise services. After the responses in the questionnaire are no longer needed, Pathfinders staff deletes it from the Cloud (Google drive). Any retained PHI is located in a HIPAA-compliant secure Electronic Health Record. If you have any questions about this form, please call 210-202-0100.

IMPORTANT NOTICE

This pre-exam paperwork will be viewed by your evaluator prior to your evaluation appointment. BUT, it is NOT immediately monitored or viewed by anyone and, thus, not an avenue for immediate help if needed.

If you need immediate medical or psychological assistance, please call 911 or present to the closest emergency room.

If you are having thoughts, you may find calling the Veterans Crisis Hotline helpful. The Veterans Crisis Hotline can be reached by calling the new three-digit number: 988.

Instructions: Each section asks about your experiences SINCE your last VA Mental Health evaluation. Please answer the questions to the best of your ability.

If a question does not pertain to you, please type N/A or leave it blank.

* Completing the questionnaire should take less than 20 minutes. Please plan accordingly.

* Your evaluator uses this questionnaire, the claims file, and the interview to create a thorough and accurate report for the VA.

IMPORTANT: Use your phone or tablet HORIZONTALLY for ideal format.

(You may not be able to read all of the items properly if you do not.)

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