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New Options for Affordable Health Insurance

Behavioral Health Management

Behavioral Health Additional Services Request - Extended Care Form 
Printable form used specifically for Additional Services

Substance Abuse Intensive Outpatient (IOP) Request Form
Printable form used specifically for Substance Abuse Intensive Outpatient Services 

Substance Abuse Partial Hospitalization (PHP) Request Form  
Printable form used specifically for Substance Abuse Partial Hospitalization services

Mental Health Intensive Outpatient Program (IOP) Request Form
Printable form used specifically for Mental Health Intensive Outpatient Services

Mental Health Partial Hospitalization Program (PHP) Request Form
Printable form used specifically for Mental Health Partial Hospitalization Program services

Psychological/Neurological Testing Request Form
Printable form used specifically for Psychological/Neurological Testing

Electroconvulsive Therapy (ECT) Initiation Request Form
Printable form used specifically for the initial Electroconvulsive Therapy services

Electroconvulsive Therapy (ECT) Continuation Request Form 
Printable form used specifically for the continuation of Electroconvulsive Therapy services