Minnesota Care Management Forms and Information

Please note – MN Care Advocate Center’s Fax # is 952-769-1390

General Forms

• Release of Information Form

Substance Abuse Forms

• Substance Abuse Continuing Care Authorization Request
• Primary Care Physician Form
• UBH Assessment Form

Day Treatment Forms

• Initial Day Treatment
• Continued Day Treatment

In-Home Professionals and Skills Forms

• Professional In-Home
• Criteria Attachment
• Skills Request

Medica Passport

• Letter to Clinicians

Treatment Plan Form
(Note: This form is not to be used for routine psychotherapy visits.)

Inpatient Consult Request Form

Retrospective Request Form

Psychological Testing Form

Initial Face to Face Form

Face to Face Update Form

ARMHS

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