Adult Behavioral Health Screening Form For Assessment And Treatment As Medically Necessary Page 2
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2Diagnostic ranges that qualify an individual for County Mental Health Services [Title 9 California Code of
Regulations Section 1830.205
1. Pervasive developmental disorders, except autistic disorders;
2. Disruptive behavior and attention deficit disorders;
3. Feeding and eating disorders of infancy and early childhood;
4. Elimination disorders;
5. Other disorders of infancy, childhood, or adolescence;
6. Schizophrenia and other psychotic disorders, except psychotic disorders due to a general medical condition;
7. Mood disorders, except mood disorders due to a general medical condition;
8. Anxiety disorders, except anxiety disorders due to a general medical condition;
9. Somatoform disorders;
10. Factitious disorders;
11. Dissociative disorders;
12. Paraphilias;
13. Gender Identity Disorder;
14. Eating disorders;
15. Impulse control disorders not elsewhere classified;
16. Adjustment disorders;
17. Personality disorders, excluding antisocial personality disorder;
18. Medication-induced movement disorders related to other included diagnoses
Impairment. As a result of one or more of diagnosed mental disorder(s) above, the patient must have a
significant impairment or probability of significant deterioration in an important area of life functioning
such as: work/school; family/ peer relationships; housing: self-care; etc.
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