IMPORTANT: Are you enrolled in Medi-Cal? Has your contact information changed in the past two years? Give your county office your updated contact information so you can stay enrolled. Go to or call the Los Angeles County Department of Public Social Services at 1-866-613-3777

Staying Healthy Forms

Staying Healthy Assessment (SHA)


As per MMCD Policy Letter 13-001, Staying Healthy Assessment (SHA) forms must be administered to new patients during the Initial Health Assessment (IHA) and periodically thereafter as the patient enters a new age category. SHA forms may be downloaded and printed in multiple age categories and languages below or from the DHCS website.

Download instructions on how to implement the SHA.

You may order hard-copy SHAs in larger quantities from L.A. Care's online health educations materials ordering application.

Click on the appropriate age group and language to download the SHA.


Prior to implementing SHA in an electronic format please complete and submit the Electronic SHA Format Notification Form.

Provider training is a required component of the new SHA. All primary care providers must take one of two online SHA trainings. A Universal SHA Provider Training is posted on the DHCS website and is appropriate for any Medi-Cal Managed Care provider within California. An additional Los Angeles County SHA Training is available for Los Angeles County providers at the top of this page. Upon completing either of these trainings please send an email to with the subject "SHA Provider Training Completed." Include your name, provider office, address, phone number and date you viewed the training in your email.

Educational materials called the "Staying Healthy" California Tip Sheets are available. The tip sheets provide helpful patient education information on the topics covered in the Staying Healthy Assessment Forms. The tip sheets are available in 10 threshold languages for Los Angeles County.

Click on the appropriate age group and language to download the "Staying Healthy" Tip Sheets:


Provider offices are strongly encouraged to use the SHA; however alternative individual health education behavioral assessment (IHEBA) tools may be used with prior approval from DHCS. Please complete and submit the Alternative IHEBA Assessment Tool Request Form.

The American Academy of Pediatrics Bright Futures assessment may be used in lieu of the SHA; however you must complete and submit the Bright Futures Assessment Tool Notification Form prior to implementation.

If you have any questions about SHA implementation please contact L.A. Care's Health Education Department at (855) 856-6943Click to Call: (855) 856-6943 or