☐ 2.2B Screening
Formerly known as Application
☐ 2.3 Consent for Treatment revised 7/9/2015
Formerly known as the Admission Agreement. This only needs to be signed once, at the beginning of service.
☐ 2.4 Decision to Enter Care revised 4/2015
☐ 2.5 Authorization for Medical Care
Formerly known as Consent for Treatment and Consent for Transportation
☐ 2.6 Authorization to Disclose Health Info revised August 2021
☐ 2.7 Privacy Practices receipt
☐ 2.9 Admission Assessment
☐ 2.10 Provider owned or controlled residential settings revised August 2021
☐ Consent to be photographed
Print complete intake packet here
Does your client need any Program/Population Specific paperwork?
Please use the comment box below to let me know how this works for your program. Thanks! Jenny