Click below for downloadable versions of UMBH supplemental outpatient treatment forms.
Transition/Termination/Discharge Plan
Maintenance Treatment Plan
Family Therapy Treatment Plan
Split Treatment Coordination Plan (for Multiple Providers)
FARS/CFARS Summary of Scores Form (NEW) - Medicaid Only
If you would like to request a copy of the Mihalik Group’s Medical Necessity Manual for Behavioral Health you must request the specific level of care criteria that you would like to review. You may request a copy of the criteria by mail, phone or by fax.
Request form for Mihalik Group’s Medical Necessity Manual for Behavioral Health
