Connecticut Department of Mental Health & Addiction Services Forms

This form is used for emergency certification of patients with psychiatric disabilities who need care and treatment in a hospital in Connecticut for up to 15 days.

This document provides information about supported recovery housing services available in Connecticut. It details the various resources, programs, and support available to individuals seeking recovery from substance abuse.

This Form is used for tracking the chain of custody of methadone take-home bottles in Connecticut.

This form is used for consultation and referral related to acquired brain injury (ABI) in Connecticut.

This type of document is used to apply for certification of intermediate duration acute care beds in the state of Connecticut.

This document is used for requesting an exception to the Csat/Opat Detox program in Connecticut. It also includes a record of the justification for the exception.

This form is used for applying for a five-day emergency commitment for alcohol or drug detoxification in the state of Connecticut. It requires a physician's certificate to support the application.

This form is used for requesting a lateral transfer within the Department of Mental Health and Addiction Services (DMHAS) in Connecticut.

This form is used for requesting a psychologist emergency examination in Connecticut.

This document is for creating a person-centered recovery plan as part of the DMHAS WISE Program in Connecticut. The plan focuses on providing individualized support and resources to help individuals on their path to recovery from mental health and substance abuse challenges.

This form is used for reviewing and revising recovery plans in the state of Connecticut.

This document is a discharge report form used in the state of Connecticut. It provides information about the release of a patient from a healthcare facility.

This form is used for obtaining a Transportation Authorization Certificate in Connecticut. It is required for individuals or businesses to operate certain types of vehicles for commercial purposes.

This type of document is used for conducting crisis evaluations in Connecticut through the DDAP program. It helps professionals assess and provide necessary support for individuals in crisis situations.

This form is used for employees in Connecticut who want to request the use of their accrued leave with workers' compensation.

This Form is used for conducting health assessments in Connecticut. It is known as the DDAP health assessment form and helps gather information about an individual's health status and any support they may need.

This document helps individuals in Connecticut keep track of their career mobility hours and balance sheet.

This Form is used for the abbreviated admission process to enter a DDAP program in Connecticut.

This form is used for the discharge of patients in Connecticut from the Department of Developmental Services (DDS) Aging and Disability Services Division (ADSD) Program.

This Form is used for admissions to the Drug Dependency Action Program (DDAP) in the state of Connecticut.

This document is used for assessing individuals who are participating in the Pre-trial Intervention Program in Connecticut.

This Form is used for conducting a supportive housing assessment in Connecticut for the Department of Developmental Services (DDS) and the Department of Housing (DOH). It helps determine eligibility and support needs for individuals seeking supportive housing.

This Form is used for the 6-month update of the DDAP Periodic Assessment in Connecticut. It helps in evaluating the progress and needs of individuals under the Department of Developmental Services.

This Form is used for updating or discharging a patient in Connecticut's Developmental Disabilities Administration Program (DDAP).

This document is a survey used in Connecticut to gather information on employment and education measures for young adults in the DDAP (Department of Developmental Services) Young Adult Services program.

This Form is used for assessing education in Connecticut by the Developmental Disabilities Planning and Assistance agency (DDAP).

This type of document is used for customer complaints in Connecticut.

This document is used for outlining the terms and conditions of a treatment agreement for individuals receiving buprenorphine treatment in Connecticut. It provides guidelines and expectations for both the healthcare provider and the patient.

This questionnaire is used in Connecticut for person-centered care planning for individuals in recovery.

This Form is used for an adapted version of the Cage-Aid questionnaire that includes questions about drug use in Connecticut.

This Form is used for requesting an alternate work schedule in the state of Connecticut. It allows employees to propose a modified work schedule to their employers.

This type of document is used to verify a medical appointment in the state of Connecticut.

This form is used for authorizing the use and disclosure of protected health information in Connecticut, and it is available in both English and Spanish.

This document is a Dmhas Data Access Form used in Connecticut. It is used to request access to data related to the Connecticut Department of Mental Health and Addiction Services (DMHAS).