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CANS Consent Documents

MassHealth Children's Behavioral Health Initiative (CBHI), Child and Adolescent Needs and Strengths (CANS)

Consent forms are used to obtain permission to share and get information for the CANS tool. Note: A prefilled cover sheet is required for faxing the Consent Information Sheet. The Consent Information Sheet must be printed directly from the CBHI CANS on the Virtual Gateway. For instructions, see page 5 of the Reference Guide: CBHI Data Entry Operator.

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CBHI CANS Consent Forms and Information Guide

Open PDF file, 689.37 KB,  CBHI CANS Consent Forms and Information Guide (English, PDF 689.37 KB)
Open DOC file, 409.5 KB,  CBHI CANS Consent Forms and Information Guide (English, DOC 409.5 KB)

English Consent Form

Open PDF file, 27.16 KB,  English Consent Form (English, PDF 27.16 KB)
Open DOC file, 35 KB,  English Consent Form (English, DOC 35 KB)

Arabic (Egyptian) Consent Form

Open PDF file, 153.84 KB,  Arabic (Egyptian) Consent Form (English, PDF 153.84 KB)
Open DOCX file, 26.69 KB,  Arabic (Egyptian) Consent Form (English, DOCX 26.69 KB)

Brazilian Portuguese Consent Form

Open PDF file, 117.95 KB,  Brazilian Portuguese Consent Form (Portuguese, Portugal, PDF 117.95 KB)
Open DOC file, 42 KB,  Brazilian Portuguese Consent Form (Portuguese, Portugal, DOC 42 KB)

Chinese Consent Form

Open PDF file, 145.64 KB,  Chinese Consent Form (Chinese, Simplified, PDF 145.64 KB)
Open DOC file, 46 KB,  Chinese Consent Form (Chinese, Simplified, DOC 46 KB)

Haitian Creole Consent Form

Open PDF file, 73.94 KB,  Haitian Creole Consent Form (Haitian Creole, PDF 73.94 KB)
Open DOC file, 56.5 KB,  Haitian Creole Consent Form (Haitian Creole, DOC 56.5 KB)

Khmer Consent Form

Open PDF file, 70.23 KB,  Khmer Consent Form (Khmer, PDF 70.23 KB)
Open DOC file, 57 KB,  Khmer Consent Form (Khmer, DOC 57 KB)

Laotian Consent Form

Open PDF file, 200.39 KB,  Laotian Consent Form (English, PDF 200.39 KB)
Open DOCX file, 22.4 KB,  Laotian Consent Form (English, DOCX 22.4 KB)

Russian Consent Form

Open PDF file, 135.23 KB,  Russian Consent Form (Russian, PDF 135.23 KB)
Open DOC file, 63 KB,  Russian Consent Form (Russian, DOC 63 KB)

Spanish Consent Form

Open PDF file, 39.51 KB,  Spanish Consent Form (Spanish, PDF 39.51 KB)
Open DOC file, 51.5 KB,  Spanish Consent Form (Spanish, DOC 51.5 KB)

Vietnamese Consent Form

Open PDF file, 106.01 KB,  Vietnamese Consent Form (Vietnamese, PDF 106.01 KB)
Open DOC file, 64.5 KB,  Vietnamese Consent Form (Vietnamese, DOC 64.5 KB)

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