Outpatient and Partial Hospitalization Forms
Outpatient forms
- Adjunct Service Prior Authorization Request Form (PDF)
- ECT Outpatient Prior Authorization Request Form (PDF)
- Assertive Community Treatment (ACT) Prior Authorization Request Form (PDF)
- Mobile MH/ID Prior Authorization Request Form — CABHC Counties Only (PDF)
- Mobile Psychiatric Nursing Request Form (PDF)
- Music Therapy Request Form (PDF)
- Peer Support Authorization Request/Discharge Form (PDF)
- Peer Support Services (PSS) Provider Listing (PDF)
- Prior Authorization for Mental Health Out of Network (OON) (PDF)
- Psychological and Neuro-Psychological Testing Request Form (PDF)
- Targeted Case Management (TCM) Discharge Report (PDF)
- TCM Mental Health (MH) Authorization Request Form (PDF)
- Transcranial Magnetic Stimulation (TMS) Prior Authorization Form (PDF)