GHS Benefit Plans
- Adults with Developmental Disabilities LOC
A description of the level of care for Adults with Developmental Disabilites. - Adults with Severe Mental Illness LOC
A description of the level of care for Adults with Severe Mental Illness and Co-Occurring Disorders - Benefit Plans - Adult DD
A grid that shows the plan service amounts per 12-month period by level of care for each service code for DD adults. - Benefit Plans - Adult MI-COD
A grid that shows the plan service amounts per 12-month period by level of care for each service code for MI or COD Adults. - Benefit Plans - Children DD
A grid that shows the plan service amounts per 12-month period by level of care for each service code for DD children. - Benefit Plans - Children SED-COD
A grid that shows the plan service amounts per 12-month period by level of care for each service code for SED and COD children. - Children LOC
A description of the level of care for Children with Severe Emotional Disorders or Developmental Disabilities. - SC/TCM Models
Basic information about Targeted Case Management, B3 Supports Coordination and Habilitation Supports Waiver Supports Coordination. - Service Authorization Packages
A listing of initial and ongoing service authorization packages for all eligibility groups.
Handouts and Administrative Clinical Forms
- AFC CLF Mentoring Request Form
- Checklist of Forms to Complete Annually
- DCH-3803
- Emergency Planning Brochure4
- GCCMH PHP Notice of Information Practices - Arabic
- GCCMH PHP Notice of Information Practices - Spanish
- Provider Reconsideration Form
- SATS
- Staging Guidelines
- Subcontracting form draft Rev 7.29.22
- Summary of Due Dates and Timeframes 09-2011
Required Clinical Forms for Contract Providers
- Consent for Treatment
- Specialized Residential PC-CLS Documentation
- Media Release of Information Authorization 2024
- Individual Budget Template 01-02-09
- IMH Psychosocial Assessment
- Community Housing Referral
- Community Housing Homeless Verification
- Consent to Exchange Health Information
- Residential Request
- GHS-GCHC Computer Acceptable Use Agreement (CAUA)
- HR Designee Instructions
- HR Designee Form
- GHS Computer Acceptable Use Agreement (CAUA) for HR Designee - BLANK
- Table of Contents - Adding Staff to CHIP