This site is part of the Louisiana Department of Health and Hospitals Network
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MHR program operations require/utilize forms that have been standardized to ensure consistency in the collection and documentation of important clinical and administrative information. The forms posted on this page must be used as formatted and may not be altered in any way. If you have a question regarding the use and standards for completing MHR forms, you may post your question on this website or contact a Network Services Representative by calling (225) 922-0006. OBH offers training sessions and workshops to outline the use and methods for completing these forms.

 

The materials posted may be in one of several different formats. If you do not have the necessary program, or require a viewer or reader to access the material, links are provided at the bottom of this page.

 

MHR Forms (11/28/2011)
Adult Level of Need Determination Form (11/28/2011)
MHR Adult Level of Need Determination Form (11/28/2011) Download file   |  View Details
Adult Level of Need Forms for LBHP (11/22/2011)
Scoring Sheet (11/22/2011) Download file   |  View Details
LOCUS Determination Grid (11/22/2011) Download file   |  View Details
Training Announcement (11/22/2011) Download file   |  View Details
Request for Service Limit Override (10/11/2010)
Request for Service Limit Override (10/11/2010) Download file   |  View Details
Medicaid Linkage/Unlinkage Form (12/17/2008)
Physician Linkage/Unlinkage (12/17/2008) Download file   |  View Details
New Authorization Request Form (11/15/2011)
MHR/MHS Authorization Request Form (11/15/2011) Download file   |  View Details
Providerlink Fax Cover Sheet (03/25/2008)
Providerlink Cover sheet (03/25/2008) Download file   |  View Details
Change Report Form (06/15/2010)
Change Report Form (06/15/2010) Download file   |  View Details
Screening Forms for Eligibility (10/18/2010)
Adult Screening (10/18/2010) Download file   |  View Details
Youth Screening (10/18/2010) Download file   |  View Details
MHR Assessments (10/17/2011)
MHR/MHS Assessment Form - Child/Adult (10/17/2011) Download file   |  View Details
Initial Assessment-Youth (08/13/2009) Download file   |  View Details
Reassessment-Youth (12/04/2007) Download file   |  View Details
Reassessment-Adults (12/04/2007) Download file   |  View Details
Initial Assessment-Adults (12/04/2007) Download file   |  View Details
Individualized Service/Recovery Plans (10/11/2010)
Individualized Service Recovery Plan (Youth and Adults) (10/11/2010) Download file   |  View Details
LOCUS and CALOCUS Scoring Sheet (10/18/2010)
CALOCUS (10/18/2010) Download file   |  View Details
LOCUS (10/18/2010) Download file   |  View Details
Request for Revision (10/11/2010)
Request for Revision (10/11/2010) Download file   |  View Details
MHRSIS Service Log (04/21/2011)
2011.04.15 Service Log Form (04/21/2011) Download file   |  View Details
Service Log (12/04/2007) Download file   |  View Details
Approved Clinical Evaluator Application (10/18/2010)
ACE Application (10/18/2010) Download file   |  View Details

 

 

 

Links to other Forms, Letters and Notes pages:

  Go to Forms, Letters and Notes Main page

  Go to DHH Letters and Wrap Session Notes page

 

 

Document Viewers & Readers:

To download the following readers/viewers, click the links below. A NEW browser window will open. Follow the instructions.

  Microsoft Word

  PowerPoint Viewer

  Adobe Acrobat Reader
 

 
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