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Forms for Providers

 

To file a complaint about a provider fill out the BHSB Complaint Form and send it to complaints@bhsbaltimore.org. To report a Sentinel Event please complete the Sentinel Events Form and email the completed form to Sentinel.Events@bhsbaltimore.org. For more information about the complaint process contact Diana Long, Incident Management & Investigations Manager at Diana.Long@bhsbaltimore.org.   

RRP Discharge Form 

For more information on Referrals and Applications for Service (Mental Health) Click here

Because each funding opportunity may call for different forms, be sure to check the Word document attached to ensure that the required forms are submitted. Please see individual description for the correct person to contact with questions or concerns.

FY 2018 Contract Process

Budget Forms 

 Contract Attachments 

Other Forms 

Maryland Gambling Treatment Services

Sentinel Event Policy and Reporting Forms

Report Due Date and Forms

Capitation Provider Forms (Reporting and Budget) 

Expanded School Mental Health Forms

Outcome Reporting Forms

If you have any questions related to the data reporting forms, please call 443-615-7806.

Value Options

Mental Hygiene Administration Forms

RRP Provider Forms