Phone: (443) 523-1700
Phone: (800) 363-8090

8928 Sign Post Road, Suite 2, Westover, MD 21871

Hours: 8 AM - 5 PM

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Local Behavioral Health Administration Forms:

lbha complaint form 

LBHA MENTAL HEALTH CONSUMER SUPPORT APPLICATION

LBHA MENTAL HEALTH CONSUMER SUPPORT APPLICATION – SPANISH

LBHA MENTAL HEALTH CONSUMER SUPPORT APPLICATION – HAITIAN CREOLE

 

Maryland RecoveryNet Forms:

MDRN CLIENT SUPPORT APPLICATION

MDRN CLIENT SUPPORT APPLICATION – SPANISH

MDRN CLIENT SUPPORT APPLICATION – HAITIAN CREOLE

 

PEER SUPPORT ADMISSION FORM

 

RESIDENTIAL REHABILITATION PROGRAM (RRP) APPLICATION

 

HOUSING APPLICATIONS:

HALS COC PERMANENT SUPPORTIVE HOUSING APPLICATION

HALS COC PERMANENT SUPPORTIVE HOUSING APPLICATION – SPANISH

HALS COC PERMANENT SUPPORTIVE HOUSING APPLICATION – HAITIAN CREOLE

 

State Care Coordination Services Referral Packet

 

Re-Entry Admission Form

 

TARGETED CASE MANAGEMENT FORMS:

TARGETED CASE MANAGEMENT PROGRAM REFERRAL

TARGETED CASE MANAGEMENT PROGRAM REFERRAL – SPANISH

TARGETED CASE MANAGEMENT PROGRAM REFERRAL – HAITIAN CREOLE

 

Homeless ID Form

HOMELESS ID FORM – SPANISH

HOMELESS ID FORM – HAITIAN CREOLE

 

AUTHORIZATION FOR RELEASE

SCHD HIPAA AUTHORIZATION

 

 

 

 

 

 

 

 

 



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