Provider Support Helping Members

Staying Healthy Assessment

The California Department of Health Care Services (DHCS) has recently updated the Staying Healthy Assessment (SHA) Individual Health Education Behavioral Assessment (IHEBA).The goals of an IHEBA, and as such the SHA, are to identify and track patient high-risk behaviors; prioritize patient health education needs; and initiate discussion and counseling on prioritized high-risk behaviors related to lifestyle, behavior, environment, culture and language.

Patient Educational Materials

Growing Up Healthy educational materials are available from DHCS. These tip sheets provide helpful patient education information on the topics covered in the Staying Healthy Assessment Forms.

CHDP Information Brochure - Growing Up Healthy

If you have questions regarding the SHA assessment forms or to request hard copies of the SHA assessment forms, including electronic versions of the assessment forms in Farsi or Khmer, please contact your local regional health plan at the appropriate phone number below.

  • Northern CA: 1-916 589-3001
  • Central CA: 1-559-353-3500
  • Southern CA: 1-818-655-1240

You may also call the Customer Care Center at 1-800-407-4627 or in Los Angeles County at 1-888-285-7801.

For more information:

For complete updated policy guidelines, please visit www.dhcs.ca.gov.

Staying Healthy Assessment Forms

in PDF Format

1 Choose an age range:

Select All

Children ages 0-6 months

Children ages 7-12 months

Children ages 1-2 years

Children ages 3-4 years

Children ages 5-8 years

Pre-adolescents 9-11 years

Adolescents 12-17 years

Adults

Seniors

2 Choose a language:

Select All

English

Russian

Korean

Khmer

Chinese

Spanish

Armenian

Farsi

Hmong

Vietnamese

Tagalog

Arabic

3 Get Forms:

Download Forms View Forms in New Window