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Module 6 of 8
OTP HH Forms
Course outline · Module 6
In this module you will find the OTP HH Eligibility and Follow-up Checklist, along with the OTP HH Receive/Resume Services form. Both are also provided in Spanish.
Eligibility checklist and Receive/Resume Services form
The OTP HH Eligibility & Follow-up Checklist must be completed at the time of admission for new patients entering the program, at admission to the Health Home program for current patients, and annually at each physical appointment. All forms and documentation should be noted in the patient's chart and kept up to date.
Patient Satisfaction Survey
Every year, the OTP Health Home Program gives patients a satisfaction survey, usually in November. Staff may use any of these approaches when distributing the survey to patients:
- Give out the survey during the last 5 minutes of group or individual counseling, and ask patients to place it in a box set aside for surveys as they leave the room.
- Give the survey with an envelope, and ask the patient to complete it while waiting for an appointment and return it to the counselor or administrative assistant.
- Ask the patient to complete it as part of their annual physical exam.
Eligibility checklist and Receive/Resume Services form
OTP Health Home Eligibility and Follow-up Checklist
OTP HH Receive/Resume Services
OTP Health Home Eligibility and Follow-up Checklist (Spanish)
OTP HH Receive/Resume Services (Spanish)
Patient Satisfaction Survey
HH Patient Satisfaction Survey (English)
HH Patient Satisfaction Survey (Spanish)