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Access Forms

• ADATC Referral 12/07
  (PDF) (Word)
• ADATC Rehab Ref Form 041807
  (PDF) (Word)
• Assignment of Case Responsibility/1st Responder - Spanish (ACR - replaced by ERF 5/3/12)
  (PDF) (Word)
• Assignment of Case Responsibility/1st Responder - English (ACR - replaced by ERF 5/3/12)
  (PDF) (Word)
• Description of Consumer Clinical Issues form 04/13/12
  (PDF) (Word)
• Enrollee Registration Form (ERF) 4/3/12
  (PDF) (Word)
• Enrollee Registration Form - Spanish (ERF) 4/3/12
  (PDF) (Word)
• LME Consumer Admission and Discharge Form (07/01/10)
  (PDF) (Word)
• Medicaid Enrollee Registration Form (MERF - replaced by ERF 5/3/12)
  (PDF) (Word)
• Medicaid Enrollee Registration Form - Spanish (MERF - replaced by ERF 5/3/12)
  (PDF) (Word)
• Medicaid Referral Form - MOA Providers
  (Word)
• Regional Assessment & Referral Form (RARF) 12/30/11
  (PDF) (Word)
• STR Registration Form (12/31/08)
  (PDF) (Word)
• Treatment Authorization Request Form (TAR) begin using 1/3/12
  (PDF) (Word)

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