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These reporting forms are required of our provider agencies on a monthly or quarterly basis, or as applicable. This list includes consultation/prevention, recovery support, and treatment reporting forms.

For more information on consultation/prevention reports, please contact the Resiliency Program Manager or Quality Improvement Coordinator.

For more information on all other reports in this section, please contact the Quality Improvement Coordinator.

• StarkMHAR Essential Reports List
• StarkMHAR Waiting List Spreadsheet
• Major Unusual Incident Report Form
• SFY25 Quality Assurance QA Report – Consultation & Prevention Services

These forms are used in an effort to place clients in a Residential Facility and for applying for Residential Housing Support (RHS).

For more information, please contact the Recovery Services Coordinator.

• SFY25 RHS Application
• SFY25 RHS Application Instructions
• SFY25 RHS Combined Change Form
• SFY25 Housing Level Of Care Placement
• SFY25 StarkMHAR Monthly PSH Report

These forms are used in an effort to place clients in a Recovery Residence (RR) and for applying for Residential Housing Assistance (RHA).

For more information, please contact the Recovery Services Coordinator.

• SFY25 RHA Application
• SFY25 RHA Application Instructions
• SFY25 RHA Combined Change Form
• SFY25 Multi Party ROI
• SFY25 Housing Level Of Care Placement

These forms are used for SUD Residential, Intensive Home-Based Treatment, and Assertive Community Treatment, and Mobile Response Stabilization Service.

For more information, please contact the Continuous Improvement Manager.

• SFY25 Prior Authorization Instructions
• SFY25 Prior Authorization Form
• SFY25 Coverage Of Benefits PA Attachment

These forms are used in an effort to coordinate treatment through Outpatient Commitment (OPC).

For more information, please contact the Forensic Coordinator.

• Affidavit of Mental Illness Form
• OPC Monthly Report Form
• Outpatient Commitment Agreement
• Outpatient Commitment Checklist for Consideration
• Guardianship v. OPC Document
• Application for Continued Commitment

These forms are used when collaboration with other agencies and/or systems are needed to assist an individual.

For more information on Flex Funds, please contact the Recovery Program Manager.
To make a referral to the Mental Illness/Intellectual Disabilities (MI/ID) Collaborative, please contact Paula Kovach at KovachP@starkdd.org.
A contact at the Coleman Crisis for Collaborative Care will be forthcoming. 
For more information on Housing Promotion, please contact the Recovery Services Coordinator.

• Flexible-CRS Funding Combined Application
• Reasons for CRS and Flex Funds
• SFY25 Flex Funds Procedure for Providers
• 2025 Collaborative Care Referral Form
• Collaborative Care Multi-Party ROI Updated 2025
• Care Plan Form Revised
• SFY25 HPM Instructions
• SFY25 HPM Request Form
• SFY25 HPM Multi Party ROI

These documents are resources for clinicians working in the school setting.

For more information on these resources, please contact the Suicide & Resiliency Services Coordinator.

• Full C-SSRS Training (PDF)
• HIPAA/FERPA Intersection Training (PPT)