Behavioral Health Templates

This Form is used for conducting a mental health assessment in behavioral healthcare settings. It helps healthcare providers evaluate and diagnose mental health conditions.

This form is used for verifying the mental health/behavioral health insurance benefits provided by the Atlanta Counseling Group LLC. It helps individuals understand their coverage and benefits for mental health services.

This Form is used for obtaining prior authorization for behavioral health services from Molina Healthcare in Ohio.

This form is used for individuals with high risk behavioral challenges in Arizona who are being discharged or transitioning to a different facility.

This document is an application form for vendors who want to be qualified to provide behavioral health clinical review criteria in Connecticut. The form is used to assess the qualifications and eligibility of vendors interested in this opportunity.

This form is used by behavioral therapy providers in Colorado to attest to their qualifications and compliance with specific requirements.

This form is used for applying for certification as a behavioral health agency in Arkansas. It is required to operate a behavioral health agency and provide services to individuals in the state.

This Form is used for applying for a new site for a behavioral health agency in Arkansas.

This form is used for screening adults for substance abuse in the state of Illinois. It helps identify individuals who may be in need of treatment or intervention for substance abuse issues.

This form is used for reporting community events related to emergency medical technicians (EMTs) and behavioral health in Missouri.

This document outlines the rights, responsibilities, and consent for individuals receiving Behavioral Health Home (BHH) services in Minnesota. It provides important information to ensure individuals understand their rights and responsibilities during their participation in BHH programs.

This form is used for screening and referring individuals with substance abuse issues in the state of Missouri.

This form is used for reporting capacity information to the Bureau of Behavioral Health Wellness and Prevention in Nevada. It helps track and monitor the availability of healthcare services related to behavioral health.

This document is a Risk Behavior Questionnaire specific to the state of Nevada. It is used to gather information about risky behaviors of individuals in Nevada.

This document is for a psychiatric evaluation required for individuals seeking long-term care in the state of New Jersey.

This Form is used for summarizing psychiatric referrals in the state of Washington.

This Form is used for creating a crisis plan that can be shared across different systems in Washington state.

This form is used for requesting authorization for outpatient or rehabilitative behavioral health services in Nevada.

This document is for the discharge summary of patients after receiving behavioral health treatment in Washington. It provides a summary of the treatment received and recommendations for continued care.

This form is used for documenting the progress of substance abuse treatment groups in Washington.

This Form is used for creating a contract addressing substance use disorder behavioral treatment in the state of Washington. It outlines the terms and responsibilities for individuals seeking treatment.

This form is used for requesting non-formulary drug use in the Behavioral Health Administration (BHA) in the state of Washington.

This form is used to schedule medical, dental, vision, hearing, or behavioral health appointments in Texas.

This document is used for the identification and screening of individuals in New Mexico who may require Level I services under the PASRR program.

This document is for renewing the registration of a person as a Registered Behavior Technician (RBT) in the state of Nevada.

This form is used for obtaining prior authorization for Applied Behavioral Analysis (ABA) services in the state of Illinois. ABA is a type of therapy that helps individuals with autism spectrum disorder improve their social, communication, and behavioral skills. Prior authorization is required to ensure coverage and reimbursement for ABA services.

This form is used for summarizing resources available at behavioral health agencies in Arkansas.