ADHD Diagnosis and Treatment Forms
The ADHD Collaborative at Cincinnati Children's Hospital Medical Center provides tracking and follow-up forms, Vanderbilt Assessment scales, management plans and evaluation packets for parents and teachers.
Tracking
Patient Log – used as a tool to track newly evaluated patients and ensure patients are receiving follow-up care at guideline recommended intervals
Vanderbilt Assessment Scales for ADHD Diagnosis
The AAP and Cincinnati Children's Hospital Medical Center guidelines recommend that an ADHD diagnosis be DSM-based. This requires that symptoms and impairment be documented in home and school settings and that alternative diagnoses are ruled out. Use of the Vanderbilt rating scales is encouraged because they enable primary care providers to screen for symptoms, impairment, and presence of the most common psychiatric comorbidities found in elementary school aged children. The Vanderbilt scales should be used in combination with a comprehensive review of the child's medical, developmental, educational, social, and family histories.
The following Vanderbilt scales can be customized to work with your office's contact information to enable parents and teachers to mail or fax completed forms to the office. Access these forms in portable document format (.pdf) and as Microsoft Word document (.doc).
Follow-up Vanderbilt scales enable the primary care provider to document and quantitatively track response to treatment (through the use of the TSS, Total Symptom Score) and monitor side-effects. Follow-Up Vanderbilt scales should be completed by the parent(s) and teacher(s) within 6 weeks of medication initiation. Access these forms in portable document format (.pdf) and as Microsoft Word document (.doc).
Tools for Scoring and Interpreting Initial and Follow-up Rating Scales
Access these forms in portable document format (.pdf).
Telephone Follow-Up Encounter Form
Telephone follow-up should be conducted within 7 – 14 days for all newly diagnosed ADHD patients who are started on medication. This scripted encounter form standardizes necessary follow-up questions so that phone calls can be made by non-physician staff members. Access these forms in portable document format (.pdf).
Written ADHD Care Management Plan
The purpose of the Written Care Management Plan is to help the child and family manage his or her ADHD. Recommended elements of a written care management plan include: goals, treatment plan, expectation for how follow-up will occur, and a scorecard for monitoring response to treatment. Access these forms in portable document format (.pdf).
Sample ADHD Evaluation Packet
It can be helpful to provide an information packet to families when the assessment of ADHD is initiated to ensure that offices expectations regarding diagnosing ADHD are clearly spelled out. Frequently, offices include the cover letters listed below in addition to Initial Parent and Teacher Vanderbilt Rating Scales. Access these forms in portable document format (.pdf).
Sample ADHD Treatment Packet
It can be helpful to provide an information packet to families when treatment of ADHD is initiated to ensure that offices expectations regarding treatment are clearly defined. Frequently, offices include the cover letters and resource information in addition to Follow-Up Parent and Teacher Vanderbilt Rating Scales. Access these forms in portable document format (.pdf).
ADHD Billing and Coding
The following information sheet includes all billing information and codes regarding billing assessment, billing for the collection of ADHD rating scales, billing for telephone calls, and billing for online communication. Access these forms in portable document format (.pdf).
ADHD Visit Encounter Forms
The following forms are used during the assessment and treatment of ADHD. Access these forms as Microsoft Word documents (.doc).
