- Application coversheet
- Facility-based respite application form
- Individualized mental health safety (state form 56901)
- Memo of Clarification and Revised Gambling Services Policy
- The Residential/Hospital/Sentinel Event/A.C.T. Incident Report form can be found online. (State Form - 53808 (12-08) / DMHA 1011). The form may be printed and manually filled out or may be filled out electronically. However, please be advised that electronically this is a “fill in” PDF form which can be filled out electronically and printed but cannot be saved.
- OTP: Request for Authorization for Patient to Receive More Than Fourteen (14) Days of Unsupervised Medication - State Form 54177
- OTP: Incident Report - State Form 54850
- Provider demographic application
- Rendering services provider application for individuals requesting authorization as a provider of wraparound facilitation, habilitation, respite and/or training and support for the unpaid caregiver services