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FmabJMzKvZ7jAXyREiZnDWfk9eMysSpfGGwPeGbGE9dqzRHzx4caeWxXof5nwdySPimpZtS4owTrV2KRodmnkcfkYBKkvhLD2IrLdQF

OPAL-K Orientation Form & Registration

OPAL-K
3161 SW Pavilion Loop
MNP 2300
Portland, OR 97239
Tel 503-346-1000 or toll free 855-966-7255
Fax 503-346-1389
Email: OPAL@ohsu.edu

Welcome to the Oregon Psychiatric Access Line

Please review the introductory material below.
Thank you.

OPAL-K Orientation Handout for Pediatricians and other Primary Care Clinicians

Vision Statement:
The vision of OPAL-K is to expand the availability of high quality mental health treatment to children of Oregon through the support of the "medical home" via timely psychiatric consultation, clinician education, primary care treatment algorithms, and promotion of linkages with private and public community mental health professionals.

OPAL-K is:
- A program that provides same day phone consultation for psychiatric questions
- A program that provides evidence-based practice data support to primary care clinicians in need of psychiatric treatment information
- A program that provides practical advice to primary care clinicians providing mental health care in the medical home of Coordinated Care Organizations (CCOs)

OPAL-K is not:
- A substitute for emergency room assessment of psychiatric emergencies
- A substitute for inpatient psychiatric care or referrals
- A substitute for community mental health clinic programs providing specialty care to special needs youth
- A program that focuses only on medication issues

I understand and agree with OPAL-K's outline and terms.

* must provide value

Yes

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First Name:

* must provide value

Last Name:

* must provide value

Business phone number:

* must provide value

Second phone number (mobile):

Preferred Method to receive consult summaries:

* must provide value

Email - secure email provided to your existing account via https://securemail.ohsu.edu

Fax - number provided is in a secure location

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Email address:

* must provide value

Fax number:

Street address 1

Street address 2 (or company/practice name)

Practice location: (city)

* must provide value

State

Zip code

Practice location (county):

Provider Type:

Provider Other type:

Specialty:

Family Practice

Pediatrics

Other (text box will open)

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Specialty Other:

Where did you hear about OPAL?

Conference

Colleague

Flyer

Website

Onsite visit from OPAL

Other (box will open)

Where did you hear about OPAL - other details:

Today's date:

M-D-Y H:M

Strongly Disagree

Disagree

Agree

Strongly Agree

There is adequate access to child psychiatry for my patients.

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With existing resources, I am usually able to meet the needs of children with psychiatric problems.

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I am able to consult with a child psychiatrist in a timely manner.

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