School Based Health Center Provider Enrollment

To expedite access to Illinois DocAssist's free services for SBHC providers we are offering enrollment

What are the benefits of enrollment with Illinois DocAssist?

While enrollment is not required to use Illinois DocAssist, enrollment comes with the following benefits:

Prompt access to consultation- complete the triage process efficiently and connect to a consultant quickly each time you contact Illinois DocAssist.
Priority access to Illinois DocAssist consultation services, continuing educational services and treatment referral assistance.
Access to Illinois DocAssist’s data regarding your utilization of Illinois DocAssist services.
Provision of an Illinois DocAssist welcome gift bag and other promotional items.

What does enrollment require of me?

Completion of an enrollment form and agreement (below) online or over the phone- 2 minutes to complete.
A brief orientation to Illinois DocAssist consultation process and services - can be completed during your first consultation.

Enrollment agreement

Illinois DocAssist enrollment agreement

IDA enrollment agreement

The intent of the Illinois DocAssist program is to provide support for providers and health professionals to assist in the management of pediatric (age 0 through 21) and perinatal populations with mental health and substance use concerns. Additionally, Illinois DocAssist can provide referral support for those patients who are considered beyond the scope of school or primary care practice. Illinois DocAssist services are free.

To accomplish this, Illinois DocAssist will maintain provider-to-provider phone consultation services Monday-Fridays 9-5, excluding holidays.

The following are expected of providers when using Illinois DocAssist services:

1. I agree to participate in the Illinois DocAssist program, which is a free service.
2. I understand that it is not an emergency referral service; Illinois DocAssist does not provide emergency evaluations over the phone or in person.
3. I understand that telephone consultations are educational in nature and that I remain fully responsible for any and all clinical management decisions for my patients.
4. I understand that the consulting psychiatrist will not be prescribing medications for my patients through Illinois DocAssist.
5. I agree to continue to manage behavioral health care of appropriate cases for primary care or school setting following the consultation.
6. I will contact Illinois DocAssist program staff with questions or concerns.
7. I agree to receive clinical and program updates as well as educational resources through email communication from the Illinois DocAssist program.
8.I may unenroll from the program at any time by submitting a request in writing.
9. I understand that any patient information provided to Illinois DocAssist team is optional AND the Illinois DocAssist team uses HIPAA compliant database ensuring confidentiality guidelines safely securing patient information.

Enrollment form

The below enrollment form will take about 2 minutes to complete. Upon submitting the form, you will receive a confirmation email. Mention that you are an enrolled provider whenever you request consultation and you will receive expedited access to free psychiatric consultation and treatment referral assistance.

Clinician's Name * Required
First Last
Preferred pronouns
Optional: NPI or UNI (School Nurse NCSBN ID)
Preferred Phone * Required
Preferred phone type
Alternate Phone
Alternate phone type
Email address * Required
Enter Email Confirm Email
Provider Type * Required
Other provider type
Provider specialty * Required
Other provider specialty
Primary Facility/Practice name * Required
Practice Type * Required
Other practice type
Facility/Practice Address * Required
Street Address Address Line 2 City State ZIP Code
County of practice
Do you have a second practice location? * Required
- Yes
- No
Second Facility/Practice name
Practice Type
Other practice type
Facility/Practice Address
Street Address Address Line 2 City State ZIP Code
County of practice
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Consent * Required
I have read the below and agree to adhere to the procedures and expectations described.
IDA registration agreement

The intent of the Illinois DocAssist program is to provide support for providers and health professionals to assist in the management of pediatric (age 0 through 21) and perinatal populations with mental health and substance use concerns. Additionally, Illinois DocAssist can provide referral support for those patients who are considered beyond the scope of school or primary care practice. Illinois DocAssist services are free.

To accomplish this, Illinois DocAssist will maintain provider-to-provider phone consultation services Monday-Fridays 9-5, excluding holidays.

The following are expected of providers when using Illinois DocAssist services:

1. I agree to participate in the Illinois DocAssist program, which is a free service.
2. I understand that it is not an emergency referral service; Illinois DocAssist does not provide emergency evaluations over the phone or in person.
3. I understand that telephone consultations are educational in nature and that I remain fully responsible for any and all clinical management decisions for my patients.
4. I understand that the consulting psychiatrist will not be prescribing medications for my patients through Illinois DocAssist.
5. I agree to continue to manage behavioral health care of appropriate cases for primary care or school setting following the consultation.
6. I will contact Illinois DocAssist program staff with questions or concerns.
7. I agree to receive clinical and program updates as well as educational resources through email communication from the Illinois DocAssist program.

8. I may unenroll from the program at any time by submitting a request in writing.
9. I understand that any patient information provided to Illinois DocAssist team is optional AND the Illinois DocAssist team uses HIPAA compliant database ensuring confidentiality guidelines safely securing patient information.
Name
This field is for validation purposes and should be left unchanged.

IllinoisDocAssist (866) 986-2778

2025 Pediatric MH Conference

School Based Health Center Provider Enrollment

Enrollment agreement

Illinois DocAssist enrollment agreement

Enrollment form

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University of Illinois at Chicago - Department of Psychiatry

2025 Pediatric MH Conference

School Based Health Center Provider Enrollment

Enrollment agreement

Read the full enrollment agreement

Illinois DocAssist enrollment agreement

Enrollment form

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