(973) 770-5505
info@caringpartnerscmo.org

Forms and Information

Family Handbook

  • Describes the process, values, policies and procedures of Wraparound and Care Management with Caring Partners.

Family Support Organization Brochure

  • A brief description of the Family Support Organization.

Grievance and Appeals Policy Notice

  • The process when there are challenges with your Care Manager.

HIPAA Privacy Notice

  • An overview of Health Insurance Portability and Accountability Act (HIPAA) and HITECH and how we safeguard and use your information.

"What is HIPAA" Brochure

  • The rights of individuals and CMO’s use of HIPAA

Third Party Liability Letter

  • Information on why CMO requests insurance information for services.

Links to Forms

Links and descriptions are provided here but these do not need to be completed unless you have been asked to complete the form by a staff member.

Publicity Consent and Release

  • Release for families to opt in using their images/artwork/writing, etc. for educational purposes, brochures, newsletters, etc. by the CMO.

CMO Initial Packet

  • Consents for Care Management, electronic communication, transport, and general information.

CMO Release

  • Release for mental health information to speak with other parties important for the Care Manager to speak with.

CMO Screening for MAID Benefits

  • Information to determine if family is eligible for Medicaid.

Collecting Documents

  • A form that allows the family to upload supporting documents such as documents needed for Medicaid: birth certificate, social security card, income verification documents, etc., or documents needed for care coordination: evaluations or Individualized Education Plans.

If you would like a copy of the youth’s record, you can use this form to request this information:

Request for Access to PHI

  • A form that allows the family/youth to request mental health records from the Care Management Organization including individual service plans, and Strength & Needs assessments.