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Children's Behavioral Health - Forms

Forms and instructions for accessing Children’s Behavioral Health Services: Habilitation Services MaineCare Section 24, 65 HCT (Children’s Home and Community and Community Based Treatment)

*For a free viewer or to request a hard copy

Contracted Provider Critical Incident Reporting
Form		Microsoft Word*	Adobe PDF*
Flex Funding Application
State Wide Flex Funding Form (This service is not an entitlement and is subject to availability of funds)		Microsoft word*
Instructions	HTML	Microsoft Word*	Adobe PDF*
Assessments
CHAT (Children's Habilitation Assessment Tool) (revised 07/01/2009)		Microsoft Word*	Adobe PDF*
Intensive Temporary Residential Treatment
Application for Intensive Temporary Residential Treatment		Microsoft Word*
Release Information
Authorization to Release Information		Microsoft Word*	Adobe PDF*
Grievance
Child or Adolescent Grievance Form (This guide includes the instructions and the form to file a grievance)		Microsoft Word*	Adobe PDF*
Home and Community Based Treatment 65 HCT
Information and Forms	HTML
Habilitation Services 24
Information and forms	HTML

 

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