Button
NumberTitleCategoriesFile TypeLinkhf:doc_categorieshf:file_type
0145ABA Consumer ProfileClinicalpdfclinicalpdf

0032

Ability to Pay – Administrative Hearing DispositionClinicalpdfclinicalpdf

0015

Ability to Pay – Administrative Hearing FindingsClinicalpdfclinicalpdf

0028

Ability to Pay – Administrative Hearing OutcomeClinicalpdfclinicalpdf

0006

Ability to Pay – Administrative Hearing RequestClinicalpdfclinicalpdf

0014

Ability to Pay – Notice of Administrative HearingClinicalpdfclinicalpdf

0034

Ability to Pay – Notice of Rights: New Rate Determination, Redetermination, & AppealsClinicalpdfclinicalpdf

0012

Ability to Pay – Request for Administrative Hearing by PhoneClinicalpdfclinicalpdf

0914

Accident Report – Non-EmployeeSafetypdfsafetypdf

0387

Acknowledgement of Receipt of “Know Your Rights” BookletClinicalpdfclinicalpdf

0916

ACT Outcomes Report with InstructionsClinicalpdfclinicalpdf

0737

Administrative Supervision SummarySupervisorypdfsupervisorypdf

0164

Adult Residential Licensing – Resident Assessment for ReimbursementClinicalpdfclinicalpdf

0275

Advance Beneficiary Notice of Non-coverage (ABN)Financepdffinancepdf

0066

Alternate Drop-Off PlanClinicalpdfclinicalpdf

1303

Appeal to Enrollment or Credentialing DenialAdminpdfadminpdf

0233

Application for Training / Endorsement / Certification ReimbursementAdminpdfadminpdf

0234

Application for Tuition ReimbursementAdminpdfadminpdf

0807

Attestation Statement for Population ServedHuman Resourcespdfhuman-resourcespdf

0262

Auditing Procedures Report – Contracting Agencies other than Residential Services ProvidersFinancepdffinancepdf

0263

Auditing Procedures Report – Residential Service ProvidersFinancepdffinancepdf

0255

Authorization Agreement for Automatic Payroll DepositsFinancepdffinancepdf

0259

Authorization Agreement for Electronic Funds TransfersFinancepdffinancepdf

0827

Authorization Consent to Access Michigan MCIRHuman Resourcespdfhuman-resourcespdf

0250

Authorization to Disclose Employee Information and Release of LiabilityRecipient Rightspdfrecipient-rightspdf

MDHHS-1183

 

Authorization to Disclose Protected Health InformationMDHHSpdfmdhhspdf

0007A

Available AssetsClinicalpdfclinicalpdf

0701

Background Check NoticeSupervisorypdfsupervisorypdf

0313

Behavior Treatment Plan Review Committee (BTPRC) ReferralClinicaldocxclinicaldocx

0326

Benefit-2-Work or Work Incentive Practitioner (WIP) ReferralClinicalpdfclinicalpdf

1041

Benzodiazepines Requirement AgreementHealth & Medicalpdfhealth-medicalpdf

0912

Bloodborne Pathogen ExposureSafetypdfsafetypdf

0101

Blue Water Area Transportation Commission Rider ProfileClinicalpdfclinicalpdf

0341

Blue Water Clubhouse Monthly ActivityClinicalpdfclinicalpdf

0113

Buprenorphine Random Count SheetHealth & Medicalpdfhealth-medicalpdf

1042

Buprenorphine Requirement AgreementHealth & Medicalpdfhealth-medicalpdf

0350

Camp Attendance LogClinicalpdfclinicalpdf

1034

Case ConsultationClinicalpdfclinicalpdf

MDHHS-1929

Central Registry Clearance RequestMDHHSpdfmdhhspdf

0024

Certification Order for Professional AssessmentClinicalpdfclinicalpdf

0386

Challenging Behavior ReferralClinicalpdfclinicalpdf

0265

Check RequestFinancepdffinancepdf

0600

Childrens Diagnostic and Treatment Specific 24 Training HoursTrainingxlsxtrainingxlsx

0369

Clinical Opiate Withdrawl Scale (COWS)Health & Medicalpdfhealth-medicalpdf

0735

Clinical/Direct Service Personnel SupervisionSupervisorydocxsupervisorydocx

0110

Clozaril White Blood Count (WBC) & Absolute Neutrophil Count (ANC) HistoryHealth & Medicalpdfhealth-medicalpdf

1352

Complaint of NoncomplianceAdminpdfadminpdf

0201

Computer / Information Systems ConsentIT & OASISpdfit-oasispdf

0205

Computer Acceptable Use AgreementIT & OASISpdfit-oasispdf

0603

Conference / Training / Workshop Follow-Up ReportTrainingpdftrainingpdf

0602

Conference / Training RequestTrainingpdftrainingpdf

0811

Confidentiality – StudentHuman Resourcespdfhuman-resourcespdf

0207

Confidentiality Agreement for Outside Contractors and Other Non-EmployeesIT & OASISpdfit-oasispdf

0200

Confidentiality and Data Security AgreementIT & OASISpdfit-oasispdf

0016

Consent – Audio / Visual AuthorizationClinicalpdfclinicalpdf

0266

Consent – Casual for a Cause Annual Payroll DeductionFinancepdffinancepdf

0381

Consent – Informed Consent for Blood DrawHealth & Medicalpdfhealth-medicalpdf

0134

Consent – Participate in Behavioral Health Telepsychiatry ServicesClinicalpdfclinicalpdf

0127

Consent – Participation in Understanding Our Sexuality: Strong, Safe, & FreeClinicalpdfclinicalpdf

0362

Consent – Spravato TreatmentHealth & Medicalpdfhealth-medicalpdf

0353

Consent – Telephone Authorization Form: Guardian Consent (IPOS, Periodic Review or Amendment)Clinicalpdfclinicalpdf

0018

Consent – Telephone Authorization: Guardian ConsentClinicalpdfclinicalpdf

0150

Consent for Exercise ProgramHealth & Medicalpdfhealth-medicalpdf

0338

Consent for ObservationClinicalpdfclinicalpdf

MDHHS-5515

Consent to Share Behavioral Health Information For Care Coordination PurposesMDHHSpdfmdhhspdf

1307

Consent – Out of County Travel CISClinicalpdfclinicalpdf

0287

Contract Provider Compliance Complaints – Quarterly ReportAdminpdfadminpdf

0112

Controlled Substance Count SheetHealth & Medicalpdfhealth-medicalpdf

0267

Cost Calculation – Contract Provider Multiple RatesFinancexlsxfinancexlsx

0268

Cost Calculation – Contract Provider Single RateFinancepdffinancepdf

0269

Cost Calculation – Residential SLAFinancexlsxfinancexlsx

0251

Credit Card Charge LogFinancepdffinancepdf

0248

Credit Card – Cardholder AgreementFinancepdffinancepdf

0249

Credit Card – Receipt ExceptionFinancepdffinancepdf

0009

Credit/Debit Card Pre-AuthorizationClinicalpdfclinicalpdf

0126

Crisis Alert/Diversion Recommendations for McLarenClinicaldocxclinicaldocx

0130

Crisis Group Home DeterminationClinicalpdfclinicalpdf

1047

Crisis Safety PlanClinicalpdfclinicalpdf

MDHHS-3803

Data Sheet and Prescription For Personal Care – Recipients in Alternative Residential SettingsMDHHSpdfmdhhspdf

0700

Direct Service Activity ReviewSupervisorypdfsupervisorypdf

0799

Disclosure of Personal InvolvementHuman Resourcespdfhuman-resourcespdf

0801

Driving Record CheckHuman Resourcespdfhuman-resourcespdf

0732

Drug Testing – Consent to Diagnostic Procedure & Release of Information AuthorizationSupervisorypdfsupervisorypdf

0731

Drug Testing – Employee Certification of NotificationSupervisorypdfsupervisorypdf

0252

Emergency Check RequestFinancepdffinancepdf

0910

Emergency EventSafetypdfsafetypdf

0802

Employee Accident ReportHuman Resourcespdfhuman-resourcespdf

0702

Employee Communication MemoSupervisorypdfsupervisorypdf

0703

Employee Discipline ReportSupervisorypdfsupervisorypdf

0812

Employee Request for Transfer MemoHuman Resourcespdfhuman-resourcespdf

0707

Employee Termination – Sample Letter of Resignation or Quit AcceptanceSupervisorypdfsupervisorypdf

0705

Employee Termination Property Receipt RecordSupervisorypdfsupervisorypdf

0706

Employee Termination Sample Letter of Release During Probation or Temporary EmploymentSupervisorypdfsupervisorypdf

0819

Employee Training WorksheetHuman Resourcespdfhuman-resourcespdf

0714

Employment Reference ConsentSupervisorypdfsupervisorypdf

0831

Employment Reference ReleaseHuman Resourcespdfhuman-resourcespdf

0335

Employment Services (IPS) – Fidelity SupervisionClinicalpdfclinicalpdf

0324

Employment Services (IPS) – Follow Along Supports PlanClinicaldocxclinicaldocx

0331

Employment Services (IPS) – Job TargetClinicalpdfclinicalpdf

0323

Employment Services (IPS) – OrientationClinicaldocxclinicaldocx

0330

Employment Services (IPS) – Vocational Profile UpdateClinicaldocxclinicaldocx

0226

Facility Use RequestAdminpdfadminpdf

0003A

Financial Information and Payment Agreement (Specialized Group Homes/Foster Homes, Inpatient >60 Days)Clinicalpdfclinicalpdf

0911

Fire Drill Log and EvaluationSafetypdfsafetypdf

0230B

FOIA – Appeal Form – Appeal of DenialAdminpdfadminpdf

0230C

FOIA – Appeal Form – Excess FeeAdminpdfadminpdf

0230A

FOIA – Detailed Cost ItemizationAdminpdfadminpdf

0229

FOIA – Request for Disclosure of Public RecordsAdminpdfadminpdf

0230

FOIA – Response to Request for Public RecordsAdminpdfadminpdf

MDHHS-5926

Habilitation Supports Waiver (HSW) – Application WorksheetMDHHSpdfmdhhspdf

MDHHS-3894

Habilitation Supports Waiver (HSW) – Eligibility CertificationMDHHSpdfmdhhspdf

MDHHS-5927

Habilitation Supports Waiver (HSW) – Performance on Major Life ActivityMDHHSpdfmdhhspdf

0828

Harassment ComplaintHuman Resourcespdfhuman-resourcespdf

HCBS-NR

HCBS Non-Residential Provider ApplicationOtherdocxotherdocx

HCBS-R

HCBS Residential Provider ApplicationOtherdocxotherdocx

0055

Health Care ChronologicalHealth & Medicalpdfhealth-medicalpdf

0730

Henry Ford Employer Solutions: Employer Authorization for Treatment/BillingSupervisorypdfsupervisorypdf

0805

Hepatitis B Vaccine Consent / WaiverHuman Resourcespdfhuman-resourcespdf

0114A

Housing Fund – IntakeClinicalpdfclinicalpdf

0114

Housing Fund – MemorandumClinicalpdfclinicalpdf

0377

I/DD Employment Supports Acuity ToolClinicalpdfclinicalpdf

0913

Incident of Weapons and/or Drugs in the WorkplaceSafetypdfsafetypdf

0057

Incident ReportClinicalpdfclinicalpdf

0146

Individual Plan of Service (IPOS) Training LogClinicalpdfclinicalpdf

0316

Individual ProfileClinicalpdfclinicalpdf

0725

Industrial Health – Medical AuthorizationSupervisorypdfsupervisorypdf

0160

InSHAPE – OrientationHealth & Medicalpdfhealth-medicalpdf

0163

InShape, Bfit, Health Matters – Self Health Action Plan for EmpowermentHealth & Medicalpdfhealth-medicalpdf

0161

InShape, Bfit, Health Matters ReferralHealth & Medicalpdfhealth-medicalpdf

0162

InShape, Bfit, Health Matters- Medical ClearanceHealth & Medicalpdfhealth-medicalpdf

0002A

Installment Payment Agreement – Hospital InpatientClinicalpdfclinicalpdf

0004

Installment Payment Agreement – OutpatientClinicalpdfclinicalpdf

0002

Installment Payment Agreement – Specialized ResidentialClinicalpdfclinicalpdf

0236

Instructor Confidentiality AgreementAdminpdfadminpdf

0392

Intensive Care Coordination w/ Wraparound (ICCW) – Crisis/Safety PlanClinicalpdfclinicalpdf

0339

Intensive Care Coordination w/ Wraparound (ICCW) – Graduation SummaryClinicalpdfclinicalpdf

0394

Intensive Care Coordination w/ Wraparound (ICCW) – Initial PlanClinicalpdfclinicalpdf

0397

Intensive Care Coordination w/ Wraparound (ICCW) – Needs AssessmentClinicalpdfclinicalpdf

0395

Intensive Care Coordination w/ Wraparound (ICCW) – Strengths & Cultural DiscoveryClinicalpdfclinicalpdf

0399

Intensive Care Coordination w/ Wraparound (ICCW) – Team MembersClinicalpdfclinicalpdf

0337

Intensive Care Coordination w/ Wraparound (ICCW) – Transition PlanClinicalpdfclinicalpdf

1304

Level 1 Authorization Training AttestationAdminpdfadminpdf

0280

Location MaintenanceIT & OASISpdfit-oasispdf

0073

Maintenance / Repair RequestSafetypdfsafetypdf

0121

Medicaid Deductible WorksheetClinicalpdfclinicalpdf

0050

Medical Appointment Information RecordHealth & Medicalpdfhealth-medicalpdf

0231

Medical Records – Records Request InquiryAdminpdfadminpdf

0059

Medical Release of Information – Consent for Hepatitis B / HIV Blood Testiing (This Form is for SUD Use Only)Health & Medicalpdfhealth-medicalpdf

0384

Medication – DeliveryHealth & Medicalpdfhealth-medicalpdf

0305

Medication – DisposalHealth & Medicalpdfhealth-medicalpdf

0311

Medication – Genoa Refill RequestHealth & Medicalpdfhealth-medicalpdf

0048

Medication Administration RecordHealth & Medicalpdfhealth-medicalpdf

0049

Medication CountsHealth & Medicalpdfhealth-medicalpdf

0049A

Medication Counts – Day ProgramsHealth & Medicalpdfhealth-medicalpdf

0051

Medication Error ReportHealth & Medicalpdfhealth-medicalpdf

0008

Medication TransferHealth & Medicalpdfhealth-medicalpdf

0340

Mental Health Services Emergency Pre-Admission ScreeningClinicalpdfclinicalpdf

0388

Mental Health Treatment Order – Non-Compliance Pick-Up OrderClinicalpdfclinicalpdf

0841

Mentoring Program – Mentee ApplicationHuman Resourcespdfhuman-resourcespdf

0843

Mentoring Program – Mentee Progress NoteHuman Resourcespdfhuman-resourcespdf

0840

Mentoring Program – Mentor ApplicationHuman Resourcespdfhuman-resourcespdf

0842

Mentoring Program – Mentorship Agreement and Personal Development PlanHuman Resourcespdfhuman-resourcespdf

0206

Mobile Device Letter of AgreementIT & OASISpdfit-oasispdf

0227

Model Attestation Regarding a Requested Use or Disclosure of Protected Health Information Potentially Related to Reproductive Health CareAdminpdfadminpdf

0370

No Identification or Decline to Provide IdentificationClinicalpdfclinicalpdf

0115

Non-Crisis Group Home Agency ProfileClinicalpdfclinicalpdf

1039

Notice of DisclaimerClinicalpdfclinicalpdf

0733

Notification of Employee Performance ReviewSupervisorypdfsupervisorypdf

0286

OASIS Refresher TrainingIT & OASISpdfit-oasispdf

0334

Objective Opiate Withdrawl Scale (OOWS)Health & Medicalpdfhealth-medicalpdf

0253

On Call TimesheetFinancexlsxfinancexlsx

0601

Opportunity for Improvement PlanSupervisorypdfsupervisorypdf

1301

Organization ApplicationAdminpdfadminpdf

1302

Organizational Deemed Status RequestAdminpdfadminpdf

0254

Overnight Per Diem WorksheetFinancepdffinancepdf

0806

Overtime DocumentationHuman Resourcespdfhuman-resourcespdf

0120

Parent(S) Financial Determination for Minor Children (Less Than 18yrs.) Receiving Specialized Residential ServicesClinicalpdfclinicalpdf

0274

Patient Responsibility AgreementFinancepdffinancepdf

0274

Patient Responsibility Agreement (Spanish)Financepdffinancepdf

0124

Periodic Review Sheet for BTPRC Behavior PlansClinicaldocxclinicaldocx

0826

Personal Use of Any Cell Phone During Paid Working HoursHuman Resourcespdfhuman-resourcespdf

0830

Personnel Change of InformationHuman Resourcespdfhuman-resourcespdf

0261

Petty Cash RequestFinancepdffinancepdf

0179

Physician Referral for DietitianHealth & Medicalpdfhealth-medicalpdf

0154

Port of Hopes Inc.: Drop-In Center Eligibility VerificationClinicalpdfclinicalpdf

0125

Positive Behavior Supports SurveyClinicalpdfclinicalpdf

1300

Practitioner Application Network Enrollment and CredentialingAdminpdfadminpdf

0736

Pre-Employment Notification and AcknowledgementHuman Resourcespdfhuman-resourcespdf

0225

Prescriber Case Consultation RequestAdminpdfadminpdf

0222

Prescriber Peer ReviewAdminpdfadminpdf

1023

Prescription for OT/PT Professional AssessmentsHealth & Medicalpdfhealth-medicalpdf

0228

Program Performance Indicator (PI) Plan of CorrectionAdminpdfadminpdf

0041

Program Placement / Transfer MeetingClinicalpdfclinicalpdf

0041C

Program Placement / Transfer Meeting – Transfer Checklist (Optional)Clinicalpdfclinicalpdf

0726

Program Supervisory Plan OutlineSupervisorypdfsupervisorypdf

0221

Provider Enrollment Information and ConsentAdminpdfadminpdf

0281

Provider Enrollment – Update or Disenrollment for OASISIT & OASISpdfit-oasispdf

0256

Purchase OrderFinancexlsxfinancexlsx

0285

Quality Improvement Plan (QIP)Clinicalpdfclinicalpdf

MDHHS-0030

Recipient Rights ComplaintMDHHSpdfmdhhspdf

KIDS

Referral – Kids in Distress Services, Inc.Otherpdfotherpdf

0144

Referral – SuboxoneHealth & Medicalpdfhealth-medicalpdf

SAL-0001

Referral for the Salvation Army Social Service DepartmentOtherpdfotherpdf

MDHHS-3471

Referral Form – DHS/ SSAMDHHSpdfmdhhspdf

0327

Referral – Employment Services (IPS)Clinicalpdfclinicalpdf

0354

Referral – Intensive Care Coordination w/ Wraparound (ICCW)Clinicalpdfclinicalpdf

1306

Region 10 Conflict of Interest Attestation – Entity ProviderAdminpdfadminpdf

1305

Region 10 Conflict of Interest Attestation – Individual ProviderAdminpdfadminpdf

0373

Release – ActorClinicalpdfclinicalpdf

0374

Release – ArtworkClinicalpdfclinicalpdf

0380

Release – Authorization for Release of Information for Staff TestimonyClinicalpdfclinicalpdf

0382

Release – Newsletters, Annual Reports, Public Relations, and Related UsesClinicalpdfclinicalpdf

0375

Release – Video/PhotographClinicalpdfclinicalpdf

0376

Release – WritingClinicalpdfclinicalpdf

MDHHS-3200

Report of Actual or Suspected Child Abuse or NeglectMDHHSpdfmdhhspdf

0007

Request for a New Rate DeterminationClinicalpdfclinicalpdf

0715

Request for a Temporary Assignment or Temporary EmploymentSupervisorypdfsupervisorypdf

0917

Request for Amendment of Protected Health InformationClinicalpdfclinicalpdf

0815

Request for Leave of AbsenceHuman Resourcespdfhuman-resourcespdf

0282

Request for New Location CodeIT & OASISpdfit-oasispdf

0232

Request for Policy / Administrative Procedure ExceptionAdminpdfadminpdf

0031

Request for Transfer to an Alternate PrescriberClinicalpdfclinicalpdf

0825

Request for Tuition/Training/Endorsement/Certification ReimbursementHuman Resourcespdfhuman-resourcespdf

0223

Request to Create New GroupAdminpdfadminpdf

0264

Request to Send Responsible Party to the Credit Bureau or Write-Off AccountFinancepdffinancepdf

0271

Request to Waive Assessed Ability to Pay or Fee Per SessionFinancepdffinancepdf

BCAL-2319

Resident FundsOtherpdfotherpdf

0832

Return to Work Commitment – Paid Parental LeaveHuman Resourcespdfhuman-resourcespdf

1021

Review of OT/PT Services (Medicare only)Health & Medicalpdfhealth-medicalpdf

1038

Safety In-Home Training ChecklistClinicalpdfclinicalpdf

0734

Sample Letter of Completion of Probationary PeriodSupervisorypdfsupervisorypdf

0224

SCCCMH Conflict of Interest DisclosureAdminpdfadminpdf

0047B

Seizure – Historical Seizure ReportHealth & Medicalpdfhealth-medicalpdf

0047

Seizure – Report of SeizureHealth & Medicalpdfhealth-medicalpdf

0306

Self-Administration of Medication (SAM) Assessment ToolHealth & Medicalpdfhealth-medicalpdf

0307

Self-Administration of Medication (SAM) Weekly LogHealth & Medicalpdfhealth-medicalpdf

0123

Sentinel Event Root Cause Analysis (RCA)Clinicaldocxclinicaldocx

0276

Sliding Fee Discount Program HandbookFinancepdffinancepdf

0070

SOAR ReferralClinicalpdfclinicalpdf

0247

Special Committee/Advisory Council Member VoucherFinancepdffinancepdf

0025C

Special Consent Behavior Treatment InterventionClinicalpdfclinicalpdf

0257

Special Fund Account RequestFinancepdffinancepdf

0117

Specialized Group/Foster Homes or Inpt >60 days – Earned Income WorksheetClinicalpdfclinicalpdf

0118

Specialized Group/Foster Homes or Inpt >60 days – Fee Determination for Mental Health ServicesClinicalpdfclinicalpdf

0116

Specialized Group/Foster Homes or Inpt >60 days – Financial Ability to Pay Agreement: Summary & Signature PageClinicalpdfclinicalpdf

0119

Specialized Group/Foster Homes or Inpt >60 days – Full Financial Review Income/Expenses AnalysisClinicalpdfclinicalpdf

1024A

Specialized Residential Personal Care and Community Living Supports LogClinicalpdfclinicalpdf

0091

Specialized/Enhanced Medical Equipment and Supplies, Environmental Modifications and/or Enhanced PharmacyClinicalpdfclinicalpdf

0359

Spravato – Hamilton Depressing Rating Scale (HAM-D)Health & Medicalpdfhealth-medicalpdf

0360

Spravato – Questionnaire Regarding History of DissociationHealth & Medicalpdfhealth-medicalpdf

0361

Spravato – Screening QuestionsHealth & Medicalpdfhealth-medicalpdf

0810

Staff Attendance Record MemoHuman Resourcespdfhuman-resourcespdf

0258

Staff Credit Card RequestFinancepdffinancepdf

0728

Staff Meeting TrainingSupervisorypdfsupervisorypdf

0383

Staff Task TrackerAdminpdfadminpdf

1400

Staff Training RequestTrainingpdftrainingpdf

0029A

Standing Medication OrderHealth & Medicalpdfhealth-medicalpdf

0029B

Standing Medication Order – List for Children Ages 2 through 11 Years of AgeHealth & Medicalpdfhealth-medicalpdf

0029C

Standing Medication Order – List for Individuals 12 Years of Age and OlderHealth & Medicalpdfhealth-medicalpdf

0029

Standing Medication Order – MissedHealth & Medicalpdfhealth-medicalpdf

SSA-1945

Statement Concerning Your Employment in a Job Not Covered by Social SecuritySSApdfssapdf

1043

Stimulants Requirement AgreementHealth & Medicalpdfhealth-medicalpdf

0824

Student / Volunteer – Information/AuthorizationHuman Resourcespdfhuman-resourcespdf

0820

Student / Volunteer Data SheetHuman Resourcespdfhuman-resourcespdf

0821

Student EvaluationHuman Resourcespdfhuman-resourcespdf

0823

Student Placement ProposalHuman Resourcespdfhuman-resourcespdf

0345

Student Pre-Screen DispositionClinicalpdfclinicalpdf

0822

Student Request for PlacementHuman Resourcespdfhuman-resourcespdf

0333

Subjective Opiate Withdrawl Scale (SOWS)Health & Medicalpdfhealth-medicalpdf

LARA-210

Substance Use Disorder Programs – Complainants Appeal to the Regional Entity Rights ConsultantLARApdflarapdf

LARA-225

Substance Use Disorder Programs – Departments Investigation ReportLARApdflarapdf

LARA-205

Substance Use Disorder Programs – Program Rights Advisors Investigation ReportLARApdflarapdf

LARA-220

Substance Use Disorder Programs – Recipient Rights Appeal to the DepartmentLARApdflarapdf

LARA-200

Substance Use Disorder Programs – Recipient Rights Complaint FormLARApdflarapdf

LARA-215

Substance Use Disorder Programs – Regional Entity Rights Consultant Investigation ReportLARApdflarapdf

0378

Substance Use Disorder Services Program: Attestation Statement/Policy ReviewHuman Resourcespdfhuman-resourcespdf

0067

Summary Report for GuardianshipClinicalpdfclinicalpdf

0729

Supervisor FeedbackSupervisorypdfsupervisorypdf

FTOC

Table of Contents: FormsTable of Contentspdftable-of-contentspdf

TOC

Table of Contents: PoliciesTable of Contentspdftable-of-contentspdf

0723

Telephone Reference CheckSupervisorypdfsupervisorypdf

0260

Travel/Expense VoucherFinancexlsxfinancexlsx

0068

Treatment AgreementClinicalpdfclinicalpdf

0332

Urine Drug Screen Result RecordHealth & Medicalpdfhealth-medicalpdf

1044

Utilization Review Reconsideration and DispositionClinicalpdfclinicalpdf

0813

Vacation Cap Variance RequestHuman Resourcespdfhuman-resourcespdf

0804

Variable Work ScheduleHuman Resourcespdfhuman-resourcespdf

0343

Waiver – Choking IncidentHealth & Medicalpdfhealth-medicalpdf

0348

Waiver – Trauma-Informed Yoga Liability Waiver & ReleaseHealth & Medicalpdfhealth-medicalpdf

0814

Working Remotely PacketHuman Resourcespdfhuman-resourcespdf

0178

Wraparound Request for Services- GAP Pool FundsClinicalpdfclinicalpdf

0318

Youth Peer Support Specialist (YPSS) Consumer ProfileClinicalpdfclinicalpdf