Forms
Behavioral/Physical Health Form
Inpatient and Residential Treatment for Substance Use Disorder (SUD)
- Initial Assessment Form for Substance Use Disorder Treatment Admission (PDF)
- Reassessment Form for Continued Substance Use Disorder Treatment (PDF)
- Residential/Inpatient Substance Use Disorder Treatment Prior Authorization Request Form (PDF)
Outpatient Treatment Request (OTR) Form
- Applied Behavioral Analysis Treatment OTR (PDF)
- Applied Behavioral Analysis Treatment OTR Checklist (PDF)
- Intensive Outpatient/Day Treatment Form Mental Health/Chemical Dependency (PDF)
- Outpatient Treatment Request (OTR) Form (PDF)
- Psychological or Neuropsych Testing Authorization Request Form (PDF)