Forms and Miscellaneous Documents

• General Documentation
  • Basic Documentation Elements for Reporting Medicaid Services
  • EPSDT Implementation Directions
  • EPSDT Implementation Individual Service Teams (IST)
  • GCBH Acronym List
  • GCBH Employee Handbook
  • MHD Program Match Codes
• Forms
  • Advanced Directive Attestation
  • Application for Services and Consent (adult)
  • Application for Services and Consent (youth)
  • Application for Services and Consent - Spanish (adult)
  • Application for Services and Consent - Spanish (youth)
  • Board of Directors Conflict of Interest Annual Disclosure
  • Business Associate Addendum
  • Clinician Attestation
  • Computer and Information Security Agreement
  • Confidentiality & Security Agreement (HIPAA)
  • Data Entry Form - Demographics
  • Data Entry Form - Periodics
  • GCBH Data Certification Form
  • GCBH Decertification Form
  • Mental Health Division GAIN-SS form
  • Notice of Action
  • Notice of Determination
  • Privacy Notice
  • Privacy Notice (Spanish)
  • Single Bed Certification Worksheet

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101 N. Edison Street, Kennewick, WA 99336-1958 Phone: 509.735.8681 or 800.795.9296 Fax: 509.783.4165 Provider Login