FORMS
A
- Application For Certification of Intermediate Care Beds
- Application for State Employment/Examination
- Applications & Forms Used by Investigators (Institutional Review Board)
- APRN/LCSW Emergency Certificate
B
C
D
E
F
G
H
I
J
K
L
M
-
Medical Records Request for DMHAS-Operated Facilities (Release of Information Form for Clients)
- Mental Health Waiver Request Form
-
- Employee Payroll Reimbursement Form (Middletown)
- Employee Payroll Reimbursement Form (Waterbury)
- Employee Payroll Reimbursement Form (Bridgeport)
- Employee Payroll Reimbursement Form (Norwich)
- Employee Payroll Reimbursement Form (Stamford)
- Employee Payroll Reimbursement Form (Danbury)
- Employee Payroll Reimbursement Form (New Haven)
- Employee Payroll Reimbursement Form (Hartford)
- Employee Payroll Reimbursement Form (Torrington)
N
O
P
Q
R
- Recovery Plan - Person Centered (WISE Program)
- Recovery Plan Review/Revision (WISE Program)
- Recovery Self-Assessment Tool for Person in Recovery
- Recovery Self-Assessment Tool for Family/Significant Other
- Recovery Self-Assessment Tool for Providers
- Recovery Self-Assessment Tool for Administrators
- Recovery Supports Program (RSP) Materials
- Release of Information Forms for Clients
S
- SAPT Block Grant Application
- Screening Measures - Co-Occurring Disorders Initiative, Statewide Implementation
- Supported Recovery Housing Services - List of Sample Forms
T
- Transportation Authorization Certificate (MHCC-15)
- Travel Authorization Request (CO-112)
- Tuition Reimbursement Application (CO-101)
U
V
W
- WEBSAS Reports (requires user password)
- WITS Access and Reports ID Request Form
- WITS Help Desk Fax Cover Sheet
- Worker's Compensation Forms