Forms to stay healthy | LA Care Health Plan

Staying Healthy Assessment (SHA)

According Policy Letter MMCD 13-001, Staying Healthy Assessment (SHA) forms should be administered to new patients during the initial health assessment (IHA) and periodically thereafter as the patient enters a new age category. SHA forms can be downloaded and printed in several age categories and languages ​​below or from the DHCS website.

Download instructions on how to implement SHA.

You can order larger quantities of paper SHAs from LA Care Online Health Education Materials Ordering App.

Click on the appropriate age group and language to download the SHA.

Before implementing SHA in an electronic format, please complete and submit the Electronic notification form in SHA format.

Provider training is a mandatory component of the new SHA. All primary care providers must complete one of two online SHA trainings. A Universal SHA Provider Training is published on the DHCS website and is suitable for any Medi-Cal managed care provider in California. Additional Los Angeles County SHA training is available for Los Angeles County vendors at the top of this page. After completing one of these trainings, please send an e-mail to [email protected] with the subject “SHA Provider Training Completed”. Include your name, provider’s office, address, phone number, and date you viewed the training in your email.

Educational materials called California “Stay Healthy” tip sheets are available. The Tip Sheets provide patients with helpful information on the topics covered in the Staying Healthy Assessment Forms. Tip sheets are available in 10 Los Angeles County threshold languages.

Click on the appropriate age group and language to download the Staying Healthy tip sheets:

Supplier offices are strongly encouraged to use SHA; however, alternative Individual Health Education Behavioral Assessment (IHEBA) tools may be used with prior approval from DHCS. Please complete and submit the IHEBA Alternative Assessment Tool Request Form.

The Bright Futures assessment from the American Academy of Pediatrics can be used instead of the SHA; however, you must complete and submit the Bright Futures Assessment Tool Notification Form before implementation.

If you have any questions about implementing SHA, please contact the LA Care Health Education Department at (855) 856-6943 Or [email protected].