





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)
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)
For instructions and/or questions about these credentialing forms, please contact the CAMHD Credentialing Specialist at (808) 733-9333.
Last reviewed on October 19, 2021