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Bear River Mental Health Provider Directory (pdf)
Medicaid Member Handbook
Medicaid Member Handbook- Spanish
Any adult client who is capable has the right to make a declaration of preferences or instructions regarding their mental health treatment. An Advance Directive is a declaration that allows, or disallows, mental health treatment. You can find an example of an Advance Directive form at https://le.utah.gov/xcode/Title62A/Chapter15/62A-15-S1004.html
Authorization for Release of Records and/or Request for Access
Form used to authorize BRMH to give out health information and/or receive information from another agency/person. Also for use by BRMH clients requesting access to their own health information or for use by personal representatives.
Revocation of Auth for Release of Records - Request for Access
Client Admission Form This form can be filled out electronically and then printed out to bring in or it can be printed blank and then filled out by hand.
Personal History Packet – Adult
Personal History Packet – Youth
Authorization for Release of Records and/or Request for Access
Revocation of Auth for Release of Records Spanish
Client Admission Form Puede completar este formulario electrónicamente, o imprimirlo y completarlo a mano, y luego llevarlo a la oficina.
Personal History Packet – Adult
Personal History Packet – Youth
This information is available in paper form, free of charge, upon request. Allow five business days. |
