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​​SMART Psyciatric Medical Clearance Form 

The Alaska SMART Medical Clearance form is an effective, standardized tool for determining medical stability for patients with a psychiatric crisis in emergency contexts. Benefits can include improved patient care and more efficient care coordination.

SMART Initiative Purpose

The SMART Medical Clearance Form (SMART form) is a tool to help providers from behavioral health, including community mental health, emergency medicine, and inpatient psychiatry work harmoniously together effectively to best serve the patient’s needs.

The Medical Clearance process is used to determine whether or not a medical illness is causing or exacerbating a psychiatric condition and if the patient’s physical health is stable enough for him/ her/ them to be transferred to a psychiatric facility or other behavioral health care. Specifically, the SMART form, is intended to simplify and standardize the Medical Clearance Process when someone has come to the ED in a behavioral health crisis to be screened for admission into a psychiatric hospital or other behavioral health care. This form may also be used in other settings to help with the Medical Clearance process, such as Primary Care Settings.

Smart Clearance FormPDF  |  Cover LetterPDF  |  Hack's Impairment Index (HII) Score

Background Presentation

Dr. Anne Zink, MD, Chief Medical Officer for the Department of Health and ASTHO (Association of State and Territorial Health Officials) current President and Dr. Seth Thomas, MD, Director of Quality and Performance, CEP America Member, Board of Directors, SSVMS present the background, development and utilization by other states.

Passcode: ^85ms90c

Resources