Skip to Main Content

Office of Mental Health

PSYCKES Implementation

Consent Forms

The PSYCKES Consent and Withdrawal of Consent forms are available below in 10 languages. To use these forms, the provider “Facility Name” as well as relevant contact information must be entered in the appropriate blank spaces in the document (fillable PDF). The English and Spanish versions of the PSYCKES Consent form are also available to download within the PSYCKES application in the Registrar Menu, where the “Facility Name” will be automatically populated and contact information can be added or edited.

  • PSYCKES Consent Form:

English Spanish Arabic Chinese Haitian Creole Japanese Khmer Korean Russian Urdu

  • PSYCKES Withdrawal of Consent Form:

English Spanish Arabic Chinese Haitian Creole Japanese  KhmerKorean Russian Urdu

Levels of Access

  • Signed Consent
    • PSYCKES Consent Form
    • Behavioral Health Care Collaborative Information Sharing Consent Form
    • DOH Health Home Patient Information Sharing Consent for Adults (DOH 5055)
  • Emergency Access
  • Quality Flag Access

PSYCKES Implementation Resources

Implementation Planning Tool(“Milestones Document”) – Action plan template for PSYCKES implementation.

Policies and Procedures - Guide for creating PSYCKES policies and procedures and integrating PSYCKES into existing workflows

Training Recommendations - Guide for training staff on PSYCKES

Core Competencies Checklist – Training tool to test understanding of common PSYCKES use cases.

Comments or questions about the information on this page can be directed to the PSYCKES Team.