Provider Hub

Providers: If you need the password, please contact the Quality Improvement Coordinator at 330-455-6644. If you are searching for a Provider, click here

Clinical Forms

I. Administrative Agency Reporting Forms

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.

II. RESIDENTIAL FACILITIES and Residential Housing Support (RHS) Forms

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.

III. RECOVERY RESIDENCES AND RECOVERY HOUSING ASSISTANCE (RHA) FORMS

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.

IV. PRIOR AUTHORIZATIONS

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.

V. OUTPATIENT COMMITMENT (OPC) FORMS

VI. Collaboration and Additional Funding Supports Forms

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.

 

VII. Resources for School-Based Clinicians

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

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