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For Providers

Forms resource for Chemical Dependency Services and Mental Health Services.

  • TEAM Clinical Review Forms


    Chemical Dependency Services

  • New Inpatient & Outpatient CD Services
    Please fill out this form if you are a provider and this is the first time that you are seeking TEAM authorization for a client for any chemical-related services (IP, OP, med assisted therapy, etc.)
  • CD Treatment Progress Report
    Providers must fill out this form after the services requested from a New CD Services authorization have been exhausted, and the provider is continuing providing services to the client.
  • Mental Health Services

  • Outpatient Mental Health Services
    Please fill out this form if you are a provider and this is the first time that you are seeking TEAM authorization for a client for any outpatient mental health-related services (individual, family, medication management).
  • Additional Outpatient Mental Health Services
    Providers must fill out this form after the services requested from a New Outpatient Mental Health Services authorization have been exhausted, and the provider is continuing providing services to the client. This form can also be used to request further day treatment or PHP services.
  • Initial Inpatient Mental Health Services
    Please fill out this form if you are a provider and this is the first time that you are seeking TEAM authorization for a client for inpatient mental health-related services.
  • Additional Inpatient Mental Health Services
    Providers must fill out this form after the services requested from a New Inpatient Mental Health Services authorization have been exhausted, and the provider is continuing providing services to the client.
  • Day Treatment or Partial Hospitalization Program
    Please fill out this form if you are a provider and this is the first time that you are seeking TEAM authorization for a client for any day treatment or PHP mental health-related services. Requests for further day treatment or PHP services can be requested by filling out the “Additional Outpatient Mental Health Services” form.
  • Psychological Testing Services
    Please fill out this form if you are a provider and this is the first time that you are seeking TEAM authorization for a client for any services related to psychological testing.