Worksheet 1: the service-scope interview
Use the same question structure across the services under review. Record the answer, who provided it and the written material that supports it. SAMHSA informs the credential, treatment-method, family-participation and broader-support questions. Population and admission questions are original editorial prompts for the responsible clinical leaders. This worksheet's structure is original editorial material.
- Service and location being discussed:
- Population and needs the organization says it serves:
- Admission and exclusion questions requiring clinical review:
- Professionals responsible for delivery and credential verification:
- Family participation and communication process:
- Support coordinated outside the organization:
- Arrangements when the next care setting changes:
- Outstanding question and responsible reviewer:
Worksheet 2: the evidence register
For each item, record entity, document title, date, covered period, source, reviewer, review question and confirmed answer. Add a separate field for the missing information or requested clarification. Use a commitment field only when a person has accepted the task; a document gap alone does not establish an assignment or deadline.
Worksheet 3: the continuity planning sheet
List the work that needs an identified owner during an operational or ownership change. This is a discussion aid, not a declaration that a transfer, permission or service arrangement is complete.
- Service or responsibility affected:
- Current and proposed responsible contact:
- Information needed to carry out the role:
- Permissions and channel to confirm:
- How people receiving care will receive accurate contact information:
- Unavailable-contact or coverage question:
- Confirmation that the receiving person accepted the handoff:
- Next review point agreed by the team:
HHS's mental and behavioral-health information-sharing guidance supports the permission questions. The actual reviewing organization must establish which rules and agreements apply to its records. Keep financial-review files and identifying care records within the authorized professional channels rather than placing them in a public worksheet submission.