Credentialing

Credentialing Forms

Paraprofessional (Para) & Mental Health Professional (MHP) Forms

• CAMHD – Para & MHP Agency Credentialing Packet – 2020.03.24 eSignatures
• PARAPROFESSIONAL PROVIDER CHECKLIST Rev. 1-2017 (Word Document Download)
  • CMO SUPPLEMENTAL FORM 2018.4 (Word Document Download)
• MHP PROVIDER CHECKLIST – Rev. 1-2017 (Word Document Download)
  • Supervising MHP Exception Request Form_181029

Qualified Mental Health Professional (QMHP) Forms

• CAMHD – QMHP CAMHD Credentialing Packet – 2020.03.24 eSignatures
• QMHP PROVIDER CHECKLIST – Revised 1-2017 (Word Document Download)

Abuse and Neglect Consent Forms

• Adult Protective Services (APS-DHS1507-0114)
• Child Protective Services (CAN/S 2020.03.24 eSignatures)

Other Forms

• Request to Change Form – Rev 02-2019 (Word Document Download)
• Attestation Letter Template_Rev. 10-2018 (Word Document Download)

Last reviewed on March 25, 2020