Quality Forms

• Administrative Appeal Request Form (PDF)
• Authorization for Use or Disclosure of Health Information (PDF)
• Critical Incident Report (PDF)
• Functional Behavior Assessment (FBA) Quality Audit Tool (PDF)
• Initial Behavioral Health Rehabilitative Services (BHRS) Treatment Plan Quality Audit Tool (PDF)
• Quality Improvement Plan (PDF)
• Report of Restraint or Seclusion (PDF)

Treatment record review (TRR) tools

2021 TRR tools

• Behavioral Health Rehabilitation Services (BHRS) TRR Tool (.xls)
• Community Residential Rehabilitation-Host Home (CRR-HH) TRR Tool (.xls)
• Community Residential Rehabilitation Intensive Treatment Program (CRR-ITP) TRR Tool (.xls)
• Crisis Intervention Tool (.xls)
• Educationally Integrated Behavioral Support Program (EIBS) TRR Tool (.xls)
• Family-Based Mental Health Services (FBMHS) TRR Tool (.xls)
• Federally Qualified Health Center TRR Tool (.xls)
• Functional Family Therapy (FFT) TRR Tool (.xls)
• Intensive Behavioral Health Services (IBHS) TRR Tool (.xls)
• Intensive Day Treatment (IDT) TRR Tool (.xls)
• Juvenile Firesetters Assessment Consultation Treatment Service (JFACTS) TRR Tool (.xls)
• Mental Health Inpatient (MHIP) TRR Tool (.xls)
• Mental Health Outpatient (MHOP) TRR Tool (.xls)
• Mobile Mental Health Treatment TRR Tool (.xls)
• Mobile Psychiatric Nursing (MPN) TRR Tool (.xls)
• Multisystemic Therapy (MST) TRR Tool (.xls)
• Music Therapy TRR Tool (.xls)
• Partial Hospitalization Program (PHP) TRR Tool (.xls)
• Peer Support Services Tool (.xls)
• Psychiatric Rehabilitation Services Tool (.xls)
• Residential Treatment Facility (RTF) TRR Tool (.xls)
• Specialized In-Home Treatment Program (SPIN) TRR Tool (.xls)
• Substance Use Non-Hospital Rehabilitation TRR Tool (.xls)
• Substance Use Outpatient (SUOP) TRR Tool (.xls)
• Substance Use Partial Hospitalization Program Treatment Tool (.xls)
• Substance Use Recovery Services Tool (.xls)
• Summer Therapeutic Activities Program (STAP) TRR Tool (.xls)
• Targeted Case Management Tool (.xls)

2020 TRR tools

• Behavioral Health Rehabilitation Services (BHRS) TRR Tool 2020 (.xls)
• Community Residential Rehabilitation-Host Home (CRR-HH) TRR Tool 2020 (.xls)
• Community Residential Rehabilitation Intensive Treatment Program (CRR-ITP) TRR Tool 2020 (.xls)
• Crisis Intervention Tool 2020 (.xls)
• Educationally Integrated Behavioral Support Program (EIBS) TRR Tool 2020 (.xls)
• Family-Based Mental Health Services (FBMHS) TRR Tool 2020 (.xls)
• Federally Qualified Health Center TRR Tool 2020 (.xls)
• Functional Family Therapy (FFT) TRR Tool 2020 (.xls)
• Intensive Day Treatment (IDT) TRR Tool 2019 (.xls)
• Juvenile Firesetters Assessment Consultation Treatment Service (JFACTS) TRR Tool 2020 (.xls)
• Mental Health Inpatient (MHIP) TRR Tool 2020 (.xls)
• Mental Health Outpatient (MHOP) TRR Tool 2020 (.xls)
• Mobile Mental Health Treatment TRR Tool 2020 (.xls)
• Mobile Psychiatric Nursing (MPN) TRR Tool 2020 (.xls)
• Multisystemic Therapy (MST) TRR Tool 2020 (.xls)
• Music Therapy TRR Tool 2020 (.xls)
• Partial Hospitalization Program (PHP) TRR Tool 2020 (.xls)
• Peer Support Services Tool 2020 (.xls)
• Psychiatric Rehabilitation Services Tool 2020 (.xls)
• Residential Treatment Facility (RTF) TRR Tool 2020 (.xls)
• Specialized In-Home Treatment Program (SPIN) TRR Tool 2020 (.xls)
• Substance Use Non-Hospital Rehabilitation TRR Tool 2020 (.xls)
• Substance Use Outpatient (SUOP) TRR Tool 2020 (.xls)
• Substance Use Partial Hospitalization Program Treatment Tool 2020 (.xls)
• Substance Use Recovery Services Tool 2020 (.xls)
• Summer Therapeutic Activities Program (STAP) TRR Tool 2020 (.xls)
• Targeted Case Management Tool 2020 (.xls)