0b6f35b3de
| Name | Size |
|---|---|
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30-90-Day-Follow-Up-Report-wout-Dx.pdf
application/pdf
30-90-Day-Follow-Up-Report-wout-Dx.pdf Open Download Copy Link 14.43 KB April 14, 2023 | 14.43 KB |
| 30-Day-Follow-Up-Report.pdf application/pdf Open Download Copy Link 15.09 KB April 14, 2023 | 15.09 KB |
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Adult-Adolescent-Discharge-Survey.pdf
application/pdf
Adult-Adolescent-Discharge-Survey.pdf Open Download Copy Link 15.35 KB April 14, 2023 | 15.35 KB |
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Adult-Diagnostic-Interview.pdf
application/pdf
Adult-Diagnostic-Interview.pdf Open Download Copy Link 55.83 KB April 14, 2023 | 55.83 KB |
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Adult-Medication-Management-Assessment.pdf
application/pdf
Adult-Medication-Management-Assessment.pdf Open Download Copy Link 54.61 KB April 14, 2023 | 54.61 KB |
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Adult-Substance-Abuse-Evaluation.pdf
application/pdf
Adult-Substance-Abuse-Evaluation.pdf Open Download Copy Link 83.3 KB April 14, 2023 | 83.3 KB |
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Adut-Mental-Health-Assessment.pdf
application/pdf
Adut-Mental-Health-Assessment.pdf Open Download Copy Link 55.53 KB April 14, 2023 | 55.53 KB |
| AIMS_Form.pdf application/pdf Open Download Copy Link 17.08 KB April 14, 2023 | 17.08 KB |
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BAM-30-Day-Instrument-11-2021.pdf
application/pdf
BAM-30-Day-Instrument-11-2021.pdf Open Download Copy Link 574.27 KB April 14, 2023 | 574.27 KB |
| Billing_Sheet.pdf application/pdf Open Download Copy Link 15.83 KB April 14, 2023 | 15.83 KB |
| CAP-Assessment-Adult.pdf application/pdf Open Download Copy Link 52.41 KB April 14, 2023 | 52.41 KB |
| CAP-Assessment-Youth.pdf application/pdf Open Download Copy Link 52.62 KB April 14, 2023 | 52.62 KB |
| CASI.pdf application/pdf Open Download Copy Link 7.42 MB April 14, 2023 | 7.42 MB |
| CEU-Form-as-of-7-01-2021.pdf application/pdf Open Download Copy Link 31.73 KB April 14, 2023 | 31.73 KB |
| Charge_Entry_Log.pdf application/pdf Open Download Copy Link 8.69 KB April 14, 2023 | 8.69 KB |
| Child-Co-Occurring-Eval.pdf application/pdf Open Download Copy Link 75.13 KB April 14, 2023 | 75.13 KB |
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Child-Diagnostic-Interview.pdf
application/pdf
Child-Diagnostic-Interview.pdf Open Download Copy Link 56.92 KB April 14, 2023 | 56.92 KB |
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Child-Medication-Management-Assessment.pdf
application/pdf
Child-Medication-Management-Assessment.pdf Open Download Copy Link 53.12 KB April 14, 2023 | 53.12 KB |
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Child-Mental-Health-Assessment.pdf
application/pdf
Child-Mental-Health-Assessment.pdf Open Download Copy Link 56.28 KB April 14, 2023 | 56.28 KB |
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Child-Substance-Abuse-Evaluation.pdf
application/pdf
Child-Substance-Abuse-Evaluation.pdf Open Download Copy Link 71.24 KB April 14, 2023 | 71.24 KB |
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Client-Percep-of-Care-2019-2020.pdf
application/pdf
Client-Percep-of-Care-2019-2020.pdf Open Download Copy Link 48.48 KB April 14, 2023 | 48.48 KB |
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Clients-Rights-Agency-Policy-10-2021.pdf
application/pdf
Clients-Rights-Agency-Policy-10-2021.pdf Open Download Copy Link 129.32 KB April 14, 2023 | 129.32 KB |
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Clients-Rights-Agency-Policy-12-2018-SPANISH.pdf
application/pdf
Clients-Rights-Agency-Policy-12-2018-SPANISH.pdf Open Download Copy Link 36.57 KB April 14, 2023 | 36.57 KB |
| Co-Occurring-Evaluation.pdf application/pdf Open Download Copy Link 83.61 KB April 14, 2023 | 83.61 KB |
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Community-Support-Assessment.pdf
application/pdf
Community-Support-Assessment.pdf Open Download Copy Link 43.62 KB April 14, 2023 | 43.62 KB |
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Community_Support_Annual_Consumer_Report.pdf
application/pdf
Community_Support_Annual_Consumer_Report.pdf Open Download Copy Link 16.12 KB April 14, 2023 | 16.12 KB |
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Community_Support_Consumer_Crisis_Plan.pdf
application/pdf
Community_Support_Consumer_Crisis_Plan.pdf Open Download Copy Link 13.82 KB April 14, 2023 | 13.82 KB |
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Confidentiality_Agreement_Form_5-2017.pdf
application/pdf
Confidentiality_Agreement_Form_5-2017.pdf Open Download Copy Link 43.25 KB April 14, 2023 | 43.25 KB |
| Consent_for_Observation.pdf application/pdf Open Download Copy Link 7.61 KB April 14, 2023 | 7.61 KB |
| Consultants_Worksheet.pdf application/pdf Open Download Copy Link 20 KB April 14, 2023 | 20 KB |
| Contact_Note.pdf application/pdf Open Download Copy Link 10.62 KB April 14, 2023 | 10.62 KB |
| Crisis_Log.pdf application/pdf Open Download Copy Link 9.67 KB April 14, 2023 | 9.67 KB |
| Crisis_Response_Form.pdf application/pdf Open Download Copy Link 11.34 KB April 14, 2023 | 11.34 KB |
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CS-Flex-Funds-Reimbursement-Request-Form.pdf
application/pdf
CS-Flex-Funds-Reimbursement-Request-Form.pdf Open Download Copy Link 650.25 KB April 14, 2023 | 650.25 KB |
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CS-Mileage-Sheet-as-of-7-01-2021.pdf
application/pdf
CS-Mileage-Sheet-as-of-7-01-2021.pdf Open Download Copy Link 29.85 KB April 14, 2023 | 29.85 KB |
| CS-Referral-Form-2019.pdf application/pdf Open Download Copy Link 32.2 KB April 14, 2023 | 32.2 KB |
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Denial_of_patient_request_to_access_records.pdf
application/pdf
Denial_of_patient_request_to_access_records.pdf Open Download Copy Link 40.82 KB April 14, 2023 | 40.82 KB |
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Denial_of_pt__request_to_amend_records.pdf
application/pdf
Denial_of_pt__request_to_amend_records.pdf Open Download Copy Link 41.83 KB April 14, 2023 | 41.83 KB |
| Disclosure_Log.pdf application/pdf Open Download Copy Link 12.09 KB April 14, 2023 | 12.09 KB |
| EMDR_Consent.pdf application/pdf Open Download Copy Link 14.29 KB April 14, 2023 | 14.29 KB |
| Employee-Handbook-2021.pdf application/pdf Open Download Copy Link 452.48 KB April 14, 2023 | 452.48 KB |
| Fax-sheet-2020-logo.pdf application/pdf Open Download Copy Link 152.89 KB April 14, 2023 | 152.89 KB |
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FC_Referral_Form_to_Community_Medical_Center.pdf
application/pdf
FC_Referral_Form_to_Community_Medical_Center.pdf Open Download Copy Link 22.35 KB April 14, 2023 | 22.35 KB |
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Financial-Policy-client-8-2022.pdf
application/pdf
Financial-Policy-client-8-2022.pdf Open Download Copy Link 371.45 KB April 14, 2023 | 371.45 KB |
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Financial-Policy-SPANISH-8-2022.pdf
application/pdf
Financial-Policy-SPANISH-8-2022.pdf Open Download Copy Link 13.74 KB April 14, 2023 | 13.74 KB |
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Financial-Policy-SPANISH-10-2021.pdf
application/pdf
Financial-Policy-SPANISH-10-2021.pdf Open Download Copy Link 13.53 KB April 14, 2023 | 13.53 KB |
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Flex_Spending_Account_Claim_Form-Employee.pdf
application/pdf
Flex_Spending_Account_Claim_Form-Employee.pdf Open Download Copy Link 15.38 KB April 14, 2023 | 15.38 KB |
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Full-Fee-Cheat-Sheet-rev-8-2022.pdf
application/pdf
Full-Fee-Cheat-Sheet-rev-8-2022.pdf Open Download Copy Link 111.48 KB April 14, 2023 | 111.48 KB |
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Grievance-Policy-11-2020-SPANISH.pdf
application/pdf
Grievance-Policy-11-2020-SPANISH.pdf Open Download Copy Link 50.59 KB April 14, 2023 | 50.59 KB |
| Grievance-Policy-11-2020.pdf application/pdf Open Download Copy Link 5.11 KB April 14, 2023 | 5.11 KB |
| Group_Progress_Note.pdf application/pdf Open Download Copy Link 40.77 KB April 14, 2023 | 40.77 KB |
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Guest_speaker_agreement_form.pdf
application/pdf
Guest_speaker_agreement_form.pdf Open Download Copy Link 11.1 KB April 14, 2023 | 11.1 KB |
| Hardship_Form.pdf application/pdf Open Download Copy Link 17.49 KB April 14, 2023 | 17.49 KB |
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Healthy-Blue-IOP-Auth-request-form.pdf
application/pdf
Healthy-Blue-IOP-Auth-request-form.pdf Open Download Copy Link 1021.52 KB April 14, 2023 | 1021.52 KB |
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Healthy-Blue-Psych-Testing-Auth-request-form.pdf
application/pdf
Healthy-Blue-Psych-Testing-Auth-request-form.pdf Open Download Copy Link 809.14 KB April 14, 2023 | 809.14 KB |
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History_of_non-routine_disclosures_request.pdf
application/pdf
History_of_non-routine_disclosures_request.pdf Open Download Copy Link 29.67 KB April 14, 2023 | 29.67 KB |
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Incident-Report-Form-10-2021.pdf
application/pdf
Incident-Report-Form-10-2021.pdf Open Download Copy Link 720.52 KB April 14, 2023 | 720.52 KB |
| Injectable_Order_Form.pdf application/pdf Open Download Copy Link 34.21 KB April 14, 2023 | 34.21 KB |
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Interpretive_services_agreement_form.pdf
application/pdf
Interpretive_services_agreement_form.pdf Open Download Copy Link 42.79 KB April 14, 2023 | 42.79 KB |
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IOP-OP-Agreement-Form-3-2019.pdf
application/pdf
IOP-OP-Agreement-Form-3-2019.pdf Open Download Copy Link 45.33 KB April 14, 2023 | 45.33 KB |
| IOP-OP_sign_in_sheet.pdf application/pdf Open Download Copy Link 9.09 KB April 14, 2023 | 9.09 KB |
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Laboratory-Requisition-Form.pdf
application/pdf
Laboratory-Requisition-Form.pdf Open Download Copy Link 13.35 KB April 14, 2023 | 13.35 KB |
| Lincoln_CS_flex_funds.pdf application/pdf Open Download Copy Link 20.96 KB April 14, 2023 | 20.96 KB |
| Med-Contact-Note-5-2019.pdf application/pdf Open Download Copy Link 87.05 KB April 14, 2023 | 87.05 KB |
| Med-Error-Note-8-2022.pdf application/pdf Open Download Copy Link 86.47 KB April 14, 2023 | 86.47 KB |
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Medication-Management-Progress-Note.pdf
application/pdf
Medication-Management-Progress-Note.pdf Open Download Copy Link 43.6 KB April 14, 2023 | 43.6 KB |
| Medication-Notice-SPANISH.pdf application/pdf Open Download Copy Link 288.17 KB April 14, 2023 | 288.17 KB |
| Medication_Injection_Note.pdf application/pdf Open Download Copy Link 27.91 KB April 14, 2023 | 27.91 KB |
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Medication_Removed_for_Disposal_Form.pdf
application/pdf
Medication_Removed_for_Disposal_Form.pdf Open Download Copy Link 16.17 KB April 14, 2023 | 16.17 KB |
| MHB_Commit_90_d_wout_Dx.pdf application/pdf Open Download Copy Link 21.82 KB April 14, 2023 | 21.82 KB |
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Mileage-Sheet-as-of-7-01-2021.pdf
application/pdf
Mileage-Sheet-as-of-7-01-2021.pdf Open Download Copy Link 29.62 KB April 14, 2023 | 29.62 KB |
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MM-Client-Distribution-Log-3-2022.pdf
application/pdf
MM-Client-Distribution-Log-3-2022.pdf Open Download Copy Link 283.65 KB April 14, 2023 | 283.65 KB |
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MM-Consent-to-Give-Written-Prescriptions-to-Designee-3-2022.pdf
application/pdf
MM-Consent-to-Give-Written-Prescriptions-to-Designee-3-2022.pdf Open Download Copy Link 99.62 KB April 14, 2023 | 99.62 KB |
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MM-Medication-Notice-11-2022.pdf
MM Medication Notice, 11-2022.pdf
application/pdf
MM Medication Notice, 11-2022.pdf Open Download Copy Link 286.86 KB April 14, 2023 | 286.86 KB |
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MM-Optional-Medication-Consent-Form-4-2022.pdf
application/pdf
MM-Optional-Medication-Consent-Form-4-2022.pdf Open Download Copy Link 271.54 KB April 14, 2023 | 271.54 KB |
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MM_Symptom_Evaluation_Form.pdf
application/pdf
MM_Symptom_Evaluation_Form.pdf Open Download Copy Link 14.47 KB April 14, 2023 | 14.47 KB |
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MSPQ-Medicare-Secondary-Payor-Questionnaire.pdf
application/pdf
MSPQ-Medicare-Secondary-Payor-Questionnaire.pdf Open Download Copy Link 604.27 KB April 14, 2023 | 604.27 KB |
| NDBH-Consent-SPANISH.pdf application/pdf Open Download Copy Link 14.41 KB April 14, 2023 | 14.41 KB |
| NDBH_Consent.pdf application/pdf Open Download Copy Link 14.33 KB April 14, 2023 | 14.33 KB |
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NTC-Psychological-Testing-Request-Form.pdf
application/pdf
NTC-Psychological-Testing-Request-Form.pdf Open Download Copy Link 446.19 KB April 14, 2023 | 446.19 KB |
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NTC_IOP-Day_Treatment_Authorization_Form.pdf
application/pdf
NTC_IOP-Day_Treatment_Authorization_Form.pdf Open Download Copy Link 181.36 KB April 14, 2023 | 181.36 KB |
| OQ-45-SPANISH.pdf application/pdf Open Download Copy Link 418.02 KB April 14, 2023 | 418.02 KB |
| OQ-45_2.pdf application/pdf Open Download Copy Link 39.22 KB April 14, 2023 | 39.22 KB |
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Patient-Records-Access-Request-Form-SPANISH.pdf
application/pdf
Patient-Records-Access-Request-Form-SPANISH.pdf Open Download Copy Link 279.81 KB April 14, 2023 | 279.81 KB |
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Patient-Records-Access-Request-Form.pdf
application/pdf
Patient-Records-Access-Request-Form.pdf Open Download Copy Link 17.44 KB April 14, 2023 | 17.44 KB |
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Patient_Assistance_Tracking_Form.pdf
application/pdf
Patient_Assistance_Tracking_Form.pdf Open Download Copy Link 12.94 KB April 14, 2023 | 12.94 KB |
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Patient_request_to_amend_records.pdf
application/pdf
Patient_request_to_amend_records.pdf Open Download Copy Link 41.98 KB April 14, 2023 | 41.98 KB |
| Personnel_Check_Out_List.pdf application/pdf Open Download Copy Link 121.45 KB April 14, 2023 | 121.45 KB |
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Petty_Cash_Reimbursment_Record.pdf
application/pdf
Petty_Cash_Reimbursment_Record.pdf Open Download Copy Link 7.64 KB April 14, 2023 | 7.64 KB |
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Privacy-notice-2-pg-11-2018.pdf
application/pdf
Privacy-notice-2-pg-11-2018.pdf Open Download Copy Link 224.89 KB April 14, 2023 | 224.89 KB |
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Privacy-notice-Full-Version-11-2018.pdf
application/pdf
Privacy-notice-Full-Version-11-2018.pdf Open Download Copy Link 397.52 KB April 14, 2023 | 397.52 KB |
| Privacy-notice-in-SPANISH.pdf application/pdf Open Download Copy Link 338.48 KB April 14, 2023 | 338.48 KB |
| Progress-Note.pdf application/pdf Open Download Copy Link 36.06 KB April 14, 2023 | 36.06 KB |
| Psychological-Evaluation.pdf application/pdf Open Download Copy Link 83.74 KB April 14, 2023 | 83.74 KB |
| Purchase_Requisition.pdf application/pdf Open Download Copy Link 20.37 KB April 14, 2023 | 20.37 KB |
| Receipt_Log.pdf application/pdf Open Download Copy Link 9.25 KB April 14, 2023 | 9.25 KB |
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Registration-Consent-10-2021.pdf
application/pdf
Registration-Consent-10-2021.pdf Open Download Copy Link 476.86 KB April 14, 2023 | 476.86 KB |
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Registration-Consent-SPANISH.pdf
application/pdf
Registration-Consent-SPANISH.pdf Open Download Copy Link 283.47 KB April 14, 2023 | 283.47 KB |
| Registration-Form-10-2021.pdf application/pdf Open Download Copy Link 209.53 KB April 14, 2023 | 209.53 KB |
| Registration-Form-SPANISH.pdf application/pdf Open Download Copy Link 150.23 KB April 14, 2023 | 150.23 KB |
|
Report-of-Complaint-Rev-5-2018.pdf
application/pdf
Report-of-Complaint-Rev-5-2018.pdf Open Download Copy Link 12.32 KB April 14, 2023 | 12.32 KB |
| ROI-Disclose-Auburn-2019.pdf application/pdf Open Download Copy Link 26.93 KB April 14, 2023 | 26.93 KB |
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ROI-Disclose-Beatrice-2019.pdf
application/pdf
ROI-Disclose-Beatrice-2019.pdf Open Download Copy Link 26.8 KB April 14, 2023 | 26.8 KB |
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ROI-Disclose-Crete-2018-SPANISH.pdf
application/pdf
ROI-Disclose-Crete-2018-SPANISH.pdf Open Download Copy Link 27.63 KB April 14, 2023 | 27.63 KB |
| ROI-Disclose-Crete-2019.pdf application/pdf Open Download Copy Link 26.91 KB April 14, 2023 | 26.91 KB |
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ROI-Disclose-David-City-2019.pdf
application/pdf
ROI-Disclose-David-City-2019.pdf Open Download Copy Link 26.92 KB April 14, 2023 | 26.92 KB |
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ROI-Disclose-Fairbury-2019.pdf
application/pdf
ROI-Disclose-Fairbury-2019.pdf Open Download Copy Link 26.94 KB April 14, 2023 | 26.94 KB |
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ROI-Disclose-Falls-City-2019.pdf
application/pdf
ROI-Disclose-Falls-City-2019.pdf Open Download Copy Link 26.87 KB April 14, 2023 | 26.87 KB |
| ROI-Disclose-Geneva-2019.pdf application/pdf Open Download Copy Link 26.92 KB April 14, 2023 | 26.92 KB |
| ROI-Disclose-Lincoln-2019.pdf application/pdf Open Download Copy Link 26.95 KB April 14, 2023 | 26.95 KB |
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ROI-Disclose-Nebraska-City-2019.pdf
application/pdf
ROI-Disclose-Nebraska-City-2019.pdf Open Download Copy Link 26.97 KB April 14, 2023 | 26.97 KB |
| ROI-Disclose-Seward-2019.pdf application/pdf Open Download Copy Link 26.91 KB April 14, 2023 | 26.91 KB |
| ROI-Disclose-Wahoo-2019.pdf application/pdf Open Download Copy Link 26.92 KB April 14, 2023 | 26.92 KB |
| ROI-Disclose-York-2019.pdf application/pdf Open Download Copy Link 26.84 KB April 14, 2023 | 26.84 KB |
| ROI-Obtain-Auburn-2019.pdf application/pdf Open Download Copy Link 27.39 KB April 14, 2023 | 27.39 KB |
| ROI-Obtain-Beatrice-2019.pdf application/pdf Open Download Copy Link 27.27 KB April 14, 2023 | 27.27 KB |
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ROI-Obtain-Crete-2018-SPANISH.pdf
application/pdf
ROI-Obtain-Crete-2018-SPANISH.pdf Open Download Copy Link 28.09 KB April 14, 2023 | 28.09 KB |
| ROI-Obtain-Crete-2019.pdf application/pdf Open Download Copy Link 27.44 KB April 14, 2023 | 27.44 KB |
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ROI-Obtain-David-City-2019.pdf
application/pdf
ROI-Obtain-David-City-2019.pdf Open Download Copy Link 27.4 KB April 14, 2023 | 27.4 KB |
| ROI-Obtain-Fairbury-2019.pdf application/pdf Open Download Copy Link 27.4 KB April 14, 2023 | 27.4 KB |
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ROI-Obtain-Falls-City-2019.pdf
application/pdf
ROI-Obtain-Falls-City-2019.pdf Open Download Copy Link 27.35 KB April 14, 2023 | 27.35 KB |
| ROI-Obtain-Geneva-2019.pdf application/pdf Open Download Copy Link 27.36 KB April 14, 2023 | 27.36 KB |
| ROI-Obtain-Lincoln-2019.pdf application/pdf Open Download Copy Link 27.41 KB April 14, 2023 | 27.41 KB |
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ROI-Obtain-Nebraska-City-2019.pdf
application/pdf
ROI-Obtain-Nebraska-City-2019.pdf Open Download Copy Link 27.43 KB April 14, 2023 | 27.43 KB |
| ROI-Obtain-Seward-2019.pdf application/pdf Open Download Copy Link 27.38 KB April 14, 2023 | 27.38 KB |
| ROI-Obtain-Wahoo-2019.pdf application/pdf Open Download Copy Link 27.37 KB April 14, 2023 | 27.37 KB |
| ROI-Obtain-York-2019.pdf application/pdf Open Download Copy Link 27.32 KB April 14, 2023 | 27.32 KB |
| Sample_Log_Form.pdf application/pdf Open Download Copy Link 58.41 KB April 14, 2023 | 58.41 KB |
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SAVE_Verification_Request_Form.pdf
application/pdf
SAVE_Verification_Request_Form.pdf Open Download Copy Link 28.94 KB April 14, 2023 | 28.94 KB |
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SA_ED_Class_Registration_Form.pdf
application/pdf
SA_ED_Class_Registration_Form.pdf Open Download Copy Link 16.14 KB April 14, 2023 | 16.14 KB |
| SA_Voucher_Tracking_Form.pdf application/pdf Open Download Copy Link 19.32 KB April 14, 2023 | 19.32 KB |
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Service-Note-CS-Goals-and-Objectives.pdf
application/pdf
Service-Note-CS-Goals-and-Objectives.pdf Open Download Copy Link 35.88 KB April 14, 2023 | 35.88 KB |
| Service-Note.pdf application/pdf Open Download Copy Link 32.48 KB April 14, 2023 | 32.48 KB |
| Simple-File-List.pdf application/pdf Open Download Copy Link 1.11 MB April 14, 2023 | 1.11 MB |
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Sliding-Fee-Eligibility-Form-2-2023-SPANISH.pdf
Sliding Fee Eligibility Form 2-2023 (SPANISH).pdf
application/pdf
Sliding Fee Eligibility Form 2-2023 (SPANISH).pdf Open Download Copy Link 20.81 KB April 14, 2023 | 20.81 KB |
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Sliding-Fee-Eligibility-Form-8-2022-SPANISH.pdf
application/pdf
Sliding-Fee-Eligibility-Form-8-2022-SPANISH.pdf Open Download Copy Link 12.58 KB April 14, 2023 | 12.58 KB |
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Sliding-Fee-Eligibility-Form-rev-2-2023.pdf
Sliding Fee Eligibility Form, rev 2-2023.pdf
application/pdf
Sliding Fee Eligibility Form, rev 2-2023.pdf Open Download Copy Link 19.67 KB April 14, 2023 | 19.67 KB |
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Sliding-Fee-Eligibility-Form-rev-8-2022.pdf
application/pdf
Sliding-Fee-Eligibility-Form-rev-8-2022.pdf Open Download Copy Link 10.15 KB April 14, 2023 | 10.15 KB |
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Sliding-Fee-Memo-to-Finance-Director-10-2021.pdf
application/pdf
Sliding-Fee-Memo-to-Finance-Director-10-2021.pdf Open Download Copy Link 502.66 KB April 14, 2023 | 502.66 KB |
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Sliding_Fee-CDS_Admission_Form.pdf
application/pdf
Sliding_Fee-CDS_Admission_Form.pdf Open Download Copy Link 33.28 KB April 14, 2023 | 33.28 KB |
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Sliding_Fee-Discharge-Summary_Form.pdf
application/pdf
Sliding_Fee-Discharge-Summary_Form.pdf Open Download Copy Link 15.16 KB April 14, 2023 | 15.16 KB |
| SOQ_.pdf application/pdf Open Download Copy Link 26.52 KB April 14, 2023 | 26.52 KB |
| SOQ_Spanish.pdf application/pdf Open Download Copy Link 38.26 KB April 14, 2023 | 38.26 KB |
| Supervisory_Contact_Note.pdf application/pdf Open Download Copy Link 11.74 KB April 14, 2023 | 11.74 KB |
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TASC_Program_Referral_Form.pdf
application/pdf
TASC_Program_Referral_Form.pdf Open Download Copy Link 64.2 KB April 14, 2023 | 64.2 KB |
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Telehealth-Consent-SPANISH.pdf
application/pdf
Telehealth-Consent-SPANISH.pdf Open Download Copy Link 294.73 KB April 14, 2023 | 294.73 KB |
| Telehealth_Consent-NEW.pdf application/pdf Open Download Copy Link 501.53 KB April 14, 2023 | 501.53 KB |
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Telehealth_Patient_Satisfaction_Survey.pdf
application/pdf
Telehealth_Patient_Satisfaction_Survey.pdf Open Download Copy Link 8.46 KB April 14, 2023 | 8.46 KB |
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Time-Off-Form-3-2021-Fillable.pdf
application/pdf
Time-Off-Form-3-2021-Fillable.pdf Open Download Copy Link 151.8 KB April 14, 2023 | 151.8 KB |
| Timesheet-3-2021-Fillable.doc application/msword Download Copy Link 47.5 KB April 14, 2023 | 47.5 KB |
| Transportation_Consent.pdf application/pdf Open Download Copy Link 10.86 KB April 14, 2023 | 10.86 KB |
| Treatment-Plan-Review.pdf application/pdf Open Download Copy Link 19.34 KB April 14, 2023 | 19.34 KB |
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Updated-SA-Service-Note-Adult.pdf
application/pdf
Updated-SA-Service-Note-Adult.pdf Open Download Copy Link 43.05 KB April 14, 2023 | 43.05 KB |
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Updated-SA-Service-Note-Child.pdf
application/pdf
Updated-SA-Service-Note-Child.pdf Open Download Copy Link 37.58 KB April 14, 2023 | 37.58 KB |
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Video-filming-release-5-2022.pdf
application/pdf
Video-filming-release-5-2022.pdf Open Download Copy Link 109.09 KB April 14, 2023 | 109.09 KB |
| Voter-Registration-Form.pdf application/pdf Open Download Copy Link 74.9 KB April 14, 2023 | 74.9 KB |
| Waiting-List.pdf application/pdf Open Download Copy Link 16.36 KB April 14, 2023 | 16.36 KB |
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Waiver_of_Liability_Statement.pdf
application/pdf
Waiver_of_Liability_Statement.pdf Open Download Copy Link 10.08 KB April 14, 2023 | 10.08 KB |
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Weekly_Probation-Parole_Note.pdf
application/pdf
Weekly_Probation-Parole_Note.pdf Open Download Copy Link 6.98 KB April 14, 2023 | 6.98 KB |
| YAP-Assessment.pdf application/pdf Open Download Copy Link 33.41 KB April 14, 2023 | 33.41 KB |
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YAP-Behavioral-Health-Checklist-10-2019.pdf
application/pdf
YAP-Behavioral-Health-Checklist-10-2019.pdf Open Download Copy Link 126.45 KB April 14, 2023 | 126.45 KB |
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YAP-Demographic-Form-07-2019.pdf
application/pdf
YAP-Demographic-Form-07-2019.pdf Open Download Copy Link 91.68 KB April 14, 2023 | 91.68 KB |
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YAP-Permission-Consent-Form-07-2019.pdf
application/pdf
YAP-Permission-Consent-Form-07-2019.pdf Open Download Copy Link 17.19 KB April 14, 2023 | 17.19 KB |
| YAP-rack-card.pdf application/pdf Open Download Copy Link 447.99 KB April 14, 2023 | 447.99 KB |
| YAP-Report-Card-2018-2019.pdf application/pdf Open Download Copy Link 114.6 KB April 14, 2023 | 114.6 KB |
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YAP-Service-Agreement-07-2019.pdf
application/pdf
YAP-Service-Agreement-07-2019.pdf Open Download Copy Link 117.56 KB April 14, 2023 | 117.56 KB |
| YOQ-30-PR.pdf application/pdf Open Download Copy Link 111.26 KB April 14, 2023 | 111.26 KB |
| YOQ-30-Spanish.pdf application/pdf Open Download Copy Link 91.03 KB April 14, 2023 | 91.03 KB |
| YOQ-30SR.pdf application/pdf Open Download Copy Link 31.8 KB April 14, 2023 | 31.8 KB |
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ZOOM-Provider-Instructions-using-Individual-Account.pdf
application/pdf
ZOOM-Provider-Instructions-using-Individual-Account.pdf Open Download Copy Link 297.04 KB April 14, 2023 | 297.04 KB |
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ZOOM-Tips-for-Home-based-Telehealth.pdf
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ZOOM-Tips-for-Home-based-Telehealth.pdf Open Download Copy Link 299.96 KB April 14, 2023 | 299.96 KB |
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