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

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Substance Abuse Forms

• OSA Forms
• OSA DEEP Forms
• OSA Treatment Forms
• OSA Provider Prevention Forms
• OSA Treatment Data Systems Forms
• OSA Fiscal and Contract Forms
• OSA Safe and Drug Free Schools and Communities
• Alcohol and Drug Treatment Program Application - Application for Licensure and Certification of Substance Abuse Treatment Program

Adults with Cognitive & Physical Disabilities Forms

• Developmental Services Case Management Forms
• Application for Certification as Provider of Section 13.05, Targareted Case Management Services
• PCP Forms
• Developmental Services Forms
• Provider Resource Directory Information Forms
• Behavioral Regulations/Three Person Committee Forms
• Support waiver
• Annual Room, Board, and Occupancy Subsidy

Children's Behavioral Health Forms

• Children's Behavioral Health Provider Forms
• State wide ITRT form
• Flexible funds forms
• Behavioral Health Provider Resource Directory Forms

Behavioral Health Forms

• EIS Resource Access Forms
• EIS Data Modification Forms
• EIS Behavioral Health Forms
• EIS Computer Based Training Form
• EIS Online Report Request Form
• Behavioral Health Web Site Editorial Change Form
• Behavioral Health HIPAA Forms

Health Forms

• Disease Reporting
• Maine Occupational Disease Reporting Form
• Infectious Disease Epidemiology Program - Request for Data
• Maine Breast and Cervical Health Program Forms
• Maine Immunization Program Forms
• Pandemic Influenza Survey Form
• Infectious Disease Epidemiology Program Request for Data Form
• BIAT/SOC Elder Services Provider Forms
• MaineCare Home Health Forms
• Elder Services Online Request to Add a Web Site
• Nursing Facilities Provider Forms
• Private Duty Nursing
• Private Duty Nursing Forms
• Personal Care Assistance
• Medical Eligibility Determination (MED) Tool (V 8.0)
• Quality of Life Interview 2009 Consent Form
• OMS Provider Enrollment 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 Waste Water Plumbing Permit Labels Online 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
• Housing Resources
  • BRAP (Bridging Rental Assistance Program) (Microsoft Word*)
  • SPC Shelter Plus Care
• PASSR MI Assessment Billing Form (Microsoft Word*)
• PASRR - V. Level 1 Screens (Microsoft Word*)
• PASRR Level II Assessment Form (Microsoft Word*)

Licensing and Regulatory Forms

• Medical Facilities Unit - Incident Report Form for Nursing Facilities (Microsoft Word*)
• DLRS Sentinel Event Program Forms
• DLRS Mailing List Online Subscription Form
• Assisted Housing Program Application for waiver to lower room temperature (Microsoft Word*)
• A list of DLRS Forms
• Children's Residential Care, Shelters for Children, and Child Placing Agencies - List of Forms
• Employee Assistance Programs - Application for Licensure/Certification
• Community Service Mental Health - Application for Mental Health Agency License (Microsoft 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
• Bend the Curve
• Staff Education and Training Forms
• SETU Online Cancellation Form
• Request for ID and Password
• Post a job
• OIAS New Hire Report Form
• Contract 2009
• Contract 2010
• Multicultural Resources Update to Resource Guide Form

*For a free viewer or to request a hard copy

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