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Behavioral Health Quality Assurance Section: Forms

FY21 Quarterly Reporting and Community Action Planning Instructions

FY21 Grant Coversheets and Reports


Adult Rural Peer Support - Grant Type 200

Ambulatory Withdrawal Management - Grant Type 239

ASAM Level 3.3 Residential SUD Services - Grant Type 257

Behavioral Health Provider's Association - Grant Type 202

Bethel Sobering Center - Grant Type 203

Bethel Community Service Patrol - Grant Type 203

Chemical Dependency Professional Certification - Grant Type 206

Comprehensive Behavioral Health Treatment and Recovery Outpatient- Grant Type 208

Comprehensive Behavioral Health Treatment and Recovery - SUD Residential - Withdrawal Management - Grant Type 208

Comprehensive Behavioral Health Treatment and Recovery - Peer and Consumer Services - Grant Type 208

Emergency COVID-19 for Mental Health and Substance Use Disorder- Grant Type 255

First Episode Psychosis - Grant Type 242

Independent Case Management - Grant Type 211

Parenting with Love and Limits (BTKH) - Grant Type 205

Permanent Supportive Housing - Grant Type 235

Permeant Supportive Housing - Projects for Assistance in Transition form Homelessness - PATH - Grant Type 235

Pregnant and Parenting Women Substance Use Disorder Services - Grant Type 252

Residential Care for Children and Youth - Grant Type 231

Residential Care for Children and Youth Training - Grant Type 230

Residential Substance Use Disorder Treatment Services - Grant Type 239

Rural Recovery Housing - Grant Type 256

Sobering Center Withdrawal Management Residential SUD - Grant Type 239

State Opioid Response (SOR) - Grant Types 247, 248, 249, and 250

Substance Use Disorder Expansion - Grant Type 239

Supported Employment - Grant Type 226

Therapeutic Court - Grant Type 227

Trauma Informed Behavioral Health Services - Grant Type 232

Designated Evaluation and Treatment Program

Substance Use Disorder Travel Assistance Forms

Medicaid Client Forms - Updated 12/5/2018

Non-Medicaid Client Forms - Updated 12/5/2018