Special Edition - October 2021
Are your child's pediatrician and behavioral health provider using the Green Form?
In 2017, pediatric and behavioral health providers identified communication as a key area of improvement in coordinating care. Based on that recommendation,
CT Children's in collaboration with the CT Chapter of the American Academy of Pediatrics (CT-AAP) developed an easy-to-use communication tool that shares basic information needed to better coordinate care, referred to as the Green Form.
Green Form
What is it?
The Green Form is an easy-to-use tool to improve communication among primary care providers, behavioral health providers and families. It's a way to share basic information about the plan of care.
The front page shares basic information about the child's/youth's plan of care. The back page contains the release of information for the parent or guardian to sign.
How do I use it?
Caregivers are encouraged to ask their providers to use the Green Form. Providers then fill out the front page. Parents or guardians sign the back page.
While the initial intent of the Green Form was to improve communications between primary pediatric care and behavioral health providers, families may also choose to share this form with schools.
Benefits of using the Green Form
  • Improves communication among families, pediatric primary care, behavioral health and school based providers
  • Reduces the burden of families having to repeat basic information to multiple providers
  • Improves coordination of care
Get Involved. Contact Us!
If you would like to discuss and/or learn more about
Family Care Connections:

Call: 1-877-381-4193 Option 3

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