Forms and Reports

Below are forms and reports to be completed and submitted by North Sound BH-ASO providers to meet contract requirements.


CLIP

CLIP Application Form (Electronic | Manual)


Crisis

Acknowledgement from Agency/Care Coordinator Assignment of CR/LR/AOT Receipt and Acceptance

Client Crisis Prevention/Safety Plan (Electronic | Manual)

Clinical Crisis Recommendations (Electronic | Manual)

Crisis Alert (Electronic | Manual)

Individual Plan Legal Cover Sheet


Drug Court

Snohomish County Juvenile Drug Court Reporting Form Quarterly

Snohomish County Juvenile Drug Court Monitoring Spreadsheet


ICRS

Affidavit for Detention (Electronic | Manual)

DMHP Contact Sheet (Electronic | Manual)

Guest Data (Electronic | Manual)

Outreach Safety Screening for Dispatch

Less Restrictive Provider Agreement (Electronic | Manual)

Page 2 (DMHP Contact Sheet, Guest Data, Voluntary Contact Sheet) (Electronic | Manual)

Voluntary Contact Sheet (Electronic | Manual)

ED Attestation Form 


Joel's Law

Declaration in Support of Petition (Electronic | Manual)

How to file a Joels Law Petition

Petition for Initial Detention (Electronic | Manual)

Petition Instructions


MHBG

MHBG Report Form


Program Integrity

Compliance Training Attestation Form

Critical Incident Reporting Form

Ownership and Disclosure Form

Exclusion Attestation Form


SABG

SABG Capacity Management Report Form

ALL Opioid Outreach Monthly Reports

Opioid Outreach Reporting Form (Monthly Reporting)

PPW Housing Support Monitoring Spreadsheet

PPW Housing Support Services Monthly Report

SABG Annual Report


Single Bed Certification

Eastern State Hospital (Electronic | Manual)

Western State Hospital (Electronic | Manual)

Updated list of community hospital ET and diversion resources

SBC Data Dictionary


Utilization Management

ASO Notification Form

ASO Psychiatric Inpatient Prior Authorization


Other

Peer Bridger Log

E&T Discharge Planning Data

HARPS Participant Log

 

Suspect Fraud?

800.684.3555

Anonymously report suspected fraud, waste, or abuse to the North Sound BH-ASO Compliance Officer by using the Compliance Hotline.

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Dissatisfied with service?

888.336.6164

or visit the Ombuds website for assistance in filing a complaint or appealing a denial of service.

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