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Staying Healthy Assessment

Staying Healthy Assessment (SHA) Tool

All Gold Coast Health Plan Members are required to have a Staying Healthy Assessment (SHA) within 120 days of enrollment. The SHA can help Providers identify high-risk behavior, set priorities for behavior change and refer patients for appropriate services.

Below is a current schedule and protocol for administering the SHA tool.

Gold Coast Health Plan Members will be asked to fill out the age/language specific Staying Healthy Assessment form at the Initial Health Assessment (IHA), within 120 days of enrollment or well-care visits at your office.

Staying Healthy Assessment 

Children
0 to 6 Months
7 to 12 Months
1 to 2 years of age
3 to 4 years of age
5 to 8 years of age

One assessment for each age group, completed by parent or guardian, signed and dated by Primary Care Provider (PCP). Reviewed, dated and initialed by PCP annually thereafter.

Pre-adolescents
9 to 11 years of age

Adolescents
12 to 17 years of age
Self-administer. Reviewed, dated and initialed by PCP annually thereafter.

Adult
18 years of age and older
Self-administered, every 3 to 5 years up through age 55.

Senior
Senior age 56 and above
After age 65, self-administer per recommendation by PCP.

A complete set of SHA forms is available at www.dhcs.ca.gov.

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