Staying Healthy Assessment Forms

The California Department of Health Care Services (DHCS) requires primary care providers to administer a Staying Healthy Assessment (SHA) or approved alternate Individual Health Education Behavioral Assessment (IHEBA) on all Medi-Cal managed care members within 120 days of enrollment with CalOptima and again at defined intervals. Providers should review the Staying Healthy Assessment at every well visit.

Staying Healthy Assessment (SHA) forms for all age groups are available to download and print in Arabic, Chinese, English, Farsi, Korean, Spanish and Vietnamese within this area of the CalOptima website. Providers can also download SHA forms in a few other languages directly from the DHCS website by clicking here. Please call CalOptima’s Provider Relations department at the number below if you have questions.

Health Education Resources

Handouts and other resource materials are available for use when providing counseling and guidance on topics covered by the SHA. We welcome you to browse through the CalOptima Health and Wellness library by clicking here to find the information you need.

Please contact our Health Education department at healthpromotions@caloptima.org for more information.

Staying Healthy Assessment (0-6 Months)
Staying Healthy Assessment (7-12 Months)
Staying Healthy Assessment (1-2 Years)
Staying Healthy Assessment (3-4 Years)
Staying Healthy Assessment (5-8 Years)
Staying Healthy Assessment (9-11 Years)
Staying Healthy Assessment (12-17 Years)
Staying Healthy Assessment (Adult)
Staying Healthy Assessment (Senior)
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