Welcome to the Resources for Blueprint Clinicians Page!

We are so excited that you have chosen to participate in this exciting program with the goal of making mental health services more accessible to our community via our primary care offices! As this is an evolving part of the VCR practice this page will be growing as we learn and develop more.

Paperwork

Note you will need to make a copy of any Google Document before you can edit.

Blueprint Specific Progress Note- docx or PDF

Information about my practice- docx

Privacy Practices- PDF

Privacy Practices Signature Page- PDF

Release of Information- PDF

Telehealth Consent Form- docx

Discharge Summary- docx

Don’t forget to also include your own professional disclosure document.

Village Health Specific Versions

Information about my practice- docx

Discharge Summary- docx

Referral Resources

Google Spreadsheet-Referral Resources

Additional Resources

Referral Tracking Spreadsheet-docx

CHT Unique Encounter Collection Data- PDF