The documents below are available for provider use. To access these publications, you need Adobe Reader. Adobe Reader may be downloaded for free.

Client Record Forms 

• LME Record Review
  
• LME Record Review Summary

Consumer Choice Forms

• Documentation of Choice Memo
  
• Documentation of Consumer Choice Form
  
• Consumer Request to Change Provider Procedure
  
• Consumer Request to Change Provider Form

Consumer Safety Forms 

• Levels II and III Incident Reporting Form
  
• Provider Quarterly Incident Reporting Form

MeckCARES Forms

• Care Review Forms
  
• Notification of Out of Home Community Placement
  
• Court Report (coming soon)

MeckLINK Forms

• Consumer Admission & Discharge Form
  
• Standardized Consumer STR Interview & Registration Form
  

Target Population Forms

• Adult MH and SA Target Pop Questionnaire
  
• Child MH and SA Target Pop Questionnaire
  
• Child and Adult DD Target Pop Questionnaire

Utilization Management

• Authorization Form (PDF) (Word) 
  
• Discharge Event
  
• Non-Medicaid Appeal Request for Extension
  
• Non-Medicaid Complaint Form
  
• Out of State Placement of Child/Adolescent Forms
  
• PCP Form (Complete)
  
• PCP Form (Introduction)
  
• PCP Manual
  
• State Facility Referral Procedure

Value Option Forms

• Certificate of Need
  
• Criterion 5