Mid-South Substance Abuse Commission
Quality Forms
42 C.F.R. HIPAA MSSAC Provider Guidelines
CareNet Forms Necessary in Client Files
Client Notice of Confidentiality
Confirmation of Credentials and Qualifications
Confirmation of Training All Staff
Consumer Handbook Request Form 2009
Criminal Justice System Referral Form
Critical Incidents-Sentinel Events Data Report Form
Critical Incidents-Sentinel Events Guide
Critical Incidents-Sentinel Events Root Cause Analysis Plan Of Correction Form FY0708
Guidelines for Grievance & Appeal
MDCH
Treatment Billing Codes Based On Qualifications
New Employee Verification Form
Outstanding PIHP Performance Indicator Report
Notices of Denial, Hearing Rights, and Suspension, Reduction or Termination can now be found on Policies 2009 page, Policy Q003
Instructions Attachment A Instructions Attachment B Instructions Attachment C Instructions Attachment D Instructions Attachment E Instructions Attachment F Instructions Attachment G Instructions Attachment H: PIHP PI Report
Priority Population Waiting List Deficiencies Report Form
Priority Population Waiting List Deficiencies Guidelines
Mid-South Substance Abuse Commission Service Provider List
Risk based Provider Monitoring Plan
Risk based Provider Monitoring Tool
State Sentinel Guide for Programs
Subpoena Form 4B-Non-crime related
Subpoena Form 5B-Crime related
Transfer of Clients for Continuing Care Procedure
Walk Through Form for Providers
QUALIFICATIONS/CREDENTIALING INFORMATION
History of SA Specialist and Practitioner
MDCH Approved Specialist vs Practitioner
Staff Credentials and Qualifications Requirements
RECIPIENT RIGHTS
English Know Your Rights Brochure
Spanish Know Your Rights Brochure
Recipient Rights Services Poster Pg. 1
Recipient Rights Services Poster Pg. 2
Spanish Recipient Rights Poster Pg. 1
Spanish Recipient Rights Poster Pg. 2
Individual forms now on Policies 2009 page, Policy A007
2875 Northwind Drive * Suite. 215 * East Lansing, Michigan * 48823