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PerformCare, A Full-Service Managed Behavioral Health Care Organization
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Home > Providers > Resources and information > Quality forms

Quality Forms

  • Administrative Appeal Request Form PDF
  • Authorization for Sharing Protected Health Information PDF
    • Authorization for Sharing Protected Health Information — Part B Addendum 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

2023 – 2025 TRR tools

  • Family-Based Mental Health Services (FBMHS) TRR Tool (.xls)
  • Federally Qualified Health Center (FQHC) 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)
  • Mental Health Inpatient (MHIP) TRR Tool (.xls)
  • Mental Health Outpatient (MHOP) TRR Tool (.xls)
  • Mobile Mental Health Treatment (MMHT) TRR Tool (.xls)
  • Mobile Psychiatric Nursing (MPN) TRR Tool (.xls)
  • Music Therapy TRR Tool (.xls)
  • Psychiatric Rehabilitation TRR Tool (.xls)
  • Residential Treatment Facility (RTF) TRR Tool (.xls)
  • Substance Use Recovery Services (SURS) Tool (.xls)
  • Youth Fire-Setters Assessment Consultation Treatment Service (YFACTS) TRR Tool (.xls)
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Hours of Operation: 24 Hours a Day, 7 Days a Week
Our Address: 8040 Carlson Road, Harrisburg, PA 17112

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