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Important Forms:

January 10, 2008

Download any form you need—most are available online. If you know of a form you need, but that form has not been posted, please, contact our office during regular business hours at (620) 231-5130.

All of the files are Adobe .PDF—users will need the free Adobe Acrobat Reader to view the files.

Click here for the H2011 In-Home Family Treatment Forms for Associate Providers (Word and .PDF files).

Authorization for the Use and Disclosure of Protected Information (Release of Information)
1 Consent for Treatment and Agreement to Pay
2 Consumer Rights, Complaint Procedure, Confidentiality, Responsibility, Rules & Regulations
3 Notice of Privacy Practices
4 Intake Summary
5 Treatment Plan
6 Treatment Plan: Additional Goals Page

 

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