CANS Forms

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

Forms for completing the CANS on paper and obtaining member consent.

MassCANS Forms (Birth-Four)

If you do not have member consent to enter CANS data into the Virtual Gateway, you must document the CANS on paper. The paper version of the CANS (below) is available in both Word and PDF formats.

Additional Resources

CANS Birth through Four with SED Determination

CANS Birth through Four with SED Determination

MassCANS Forms (Five to 20)

If you do not have member consent to enter CANS data into the Virtual Gateway, you must document the CANS on paper. The paper version of the CANS (below) is available in both Word and PDF formats.

Additional Resources

CANS Five through 20 with SED Determination

CANS Five through 20 with SED Determination

CANS Rating Sheets (Birth-Four)

CANS Rating Sheets may be used in place of the long form when documenting the CANS on paper.

The CANS Rating Sheet is now available in fillable PDF format. Each format includes the SED determination. Both formats contain a header section containing space for Child's Name, Organization Name, and Other. If you are unable to see the header in the RTF format click on View in the Toolbar and then click on Print Layout to view header. The header information will appear when you print this document.

Please note: Completing a fillable PDF rating sheet does not enter the information onto the CBHI CANS Application on the Virtual Gateway.

Additional Resources

CANS Birth through Four Rating Sheet

CANS Birth through Four Rating Sheet

CANS Rating Sheets (Five to 20)

CANS Rating Sheets may be used in place of the long form when documenting the CANS on paper.

The CANS Rating Sheet is now available in fillable PDF format. Each format includes the SED determination. Both formats contain a header section containing space for Child's Name, Organization Name, and Other. If you are unable to see the header in the RTF format click on View in the Toolbar and then click on Print Layout to view header. The header information will appear when you print this document.

Please note: Completing a fillable PDF rating sheet does not enter the information onto the CBHI CANS Application on the Virtual Gateway.

Additional Resources

CANS Five through Twenty Rating Sheet

CANS Five through Twenty Rating Sheet

MassCANS Consent Documents

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.

Additional Resources

MassCANS Consent Documents