NYS Office of Mental Health
Clinic Standards of Care Survey

Agency Name
Clinic name
Operating Certificate #


1.11 Requests for services are addressed appropriately and in a timely manner

1.12 The assessment process is responsive and coordinated

1.21 The assessment is comprehensive

1.22 Screening and assessment of Co-occurring disorders

1.23 The assessment includes an initial risk of self harm

1.24 The assessment includes an initial risk of harm to others

1.25 Health screening and monitoring

1.27 Screening and assessment of tobacco use

1.31 The clinician pursues information from other sources, including family members, significant others and recent providers of service

Treatment Plan

2.11 Every recipient has a person-centered, comprehensive treatment plan

2.12 The treatment plan is developed with the recipient/family/collaterals

2.14 Treatment plan revises reflect active and ongoing reappraisal of goals, objectives, and discharge criteria

2.15 Documentation of treatment services

2.21 Safety plan

2.31 The comprehensive treatment plan is developed in a timely manner; the plan and subsequent reviews are signed by all individuals participating in the recipient's care

Ongoing Care

3.11 The clinic attends to the recipient and family

3.12 Identification of a primary clinician

3.13 Engagement and retention

3.14 Communication with families/other significant people

3.15 Co-occurring mental health and substance use disorders

3.16 Disengagement from treatment

3.17 Treatment of tobacco use

3.21 Discharge

Clinical Administration

4.11 Caseload

4.12 Treatment Services

4.13 Crisis Services

4.14 Cultural Competence

4.21 Supervison and Training

4.31 Information Sharing

4.41 Clinical Risk Management

4.51 Responsive to recipients at risk

4.61 Premises

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.