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State of Maine
Department of Health and Human Services Maine People Living Safe, Healthy and Productive Lives DHHS Õ Information for Providers Õ DHHS Provider Forms
+ A | - A | Sun 31 Dec 2017
Health and Human Services Provider Forms On this page: Substance Abuse Adults with Cognitive & Physical Disabilities Children's Behavioral Health Behavioral Health Health
Environmental Health Mental Health Licensing and Regulatory Miscellaneous
Substance Abuse Forms SA DEEP Forms SA Treatment Forms SA Treatment Data Systems Forms
Adults with Disabilities Forms Developmental Services Case Management Forms Application for Certification as Provider of Section 13.05, Targareted Case Management Services PCP Forms Provider Resource Directory Information Forms Behavioral Regulations/Three Person Committee Forms Support waiver
Children's Behavioral Health Forms Children's Behavioral Health Provider Forms State wide ITRT form Individual Planning Funds forms
Health Forms Newborn Bloodspot Screening Report of Repeat Specimens Submitted (pdf*) Newborn Bloodspot Screening Test Refusal Form (pdf*) Disease Reporting Maine Occupational Disease Reporting Form (pdf*) Infectious Disease Epidemiology Program - Request for Data Maine Breast and Cervical Health Program Forms Maine Immunization Program Forms PNMI Transfer Forms HIV, STD and Viral Hepatitis Program Forms
Environmental Health Forms Radiation Control Program Forms Subsurface Waste Water Online Feedback Form Subsurface Wastewater Program Forms Environmental Health Forms Camp Operators - Reportable/Notifiable Incident Report (HHE-627) (Adobe PDF*) Suppliers of Compressed Air for Breathing Purposes (Adobe PDF*)
Mental Health Forms Adult Mental Health Involuntary Commitment Forms Case Management Treatment Plan Review Directions (Word, Adobe PDF*) Case Management Treatment Plan Review Form (Word, Adobe PDF*) Critical Incident Reporting Form (Word*) Crisis Form for Mental Health Providers (Excel*) Housing Resources BRAP (Bridging Rental Assistance Program) SPC (Shelter Plus Care) PASSR MI Assessment Billing Form (Word*) PASRR - V. Level 1 Screens (Word*) PASRR Level II Assessment Form (Word*) Request to Terminate or Interrupt Services Form (Word, Adobe PDF*) Service Agreement Form (Word, Adobe PDF*)
Licensing and Regulatory Forms Medical Facilities Unit - Incident Report Form for Nursing Facilities (Word*) DLRS Sentinel Event Program Forms DLRS Mailing List Online Subscription Form Children's Residential Care, Shelters for Children, and Child Placing Agencies - List of Forms Employee Assistance Programs - Application for Licensure/Certification (Word*) Community Service Mental Health - Application for Mental Health Agency License (Word*) Child Care and Nursery school list of Forms DLRS Application to operate a Licensed Child Care Facility Forms
Miscellaneous Forms Child Protective Records Research Forms Maine Cemetery and Crematorium Forms Staff Education and Training Unit OFI New Hire Report Form Contracts