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FORMS

MDH Budget Forms Standard MDH Budget Forms (includes MDH 432, 433, 434, 436, etc.)

MDH Provider 440 - Instructions Providers - Please use the following forms to submit 440s to the AACMHA:

2012 Reconciliation Instructions
440 Form
440A Excel Sheet

Beacon Health Options Maryland Provider Forms

Grievance Form Grievance Form

Petition for Emergency Evaluation Petition for Emergency Evaluation

Residential Rehabilitation Program Application Form RRP Application

Release of Medical Information Authorization Authorization Form

Assertive Community Treatment Services (ACT) for Adults with Mental Illness in Anne Arundel and Prince George's Counties ACT Referral & Consent Forms

Consultant Invoice Form Sample Consultant Invoice

Death Notice BHA Death Notice Form

Beacon Health Options - Maryland Provider Manual Chapter 3 Uninsured Eligible Consumers

Advance Directive for Mental Health Treatment Advance Directive

 

Memorandum of Agreement

Please click here for MOA

Suicide Prevention Resources 

Hotlines for families and youth

Call 911 for immediate assistance in any emergency

CRISIS WARMLINE
410-768-5522
24 hours a day, 7 days a week

Maryland Youth Crisis Hotline
1-800-422-0009
24 hours a day, 7 days a week

National Suicide Prevention Hotlines

1-800-SUICIDE (784-2433)

1-800-273-TALK (8255)

Anne Arundel County Public Schools Student Safety Hotline
1-877-676-9854
24 hours a day, 7 days a week

SAMHSA Disaster Distress Helpline
1-800-985-5990
Text: "TalkWithUs" to 66746

More Information 

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RFP/RFI

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Programs/Services 

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Minority Outreach

People with Disabilities

Veterans

©Anne Arundel County Mental Health Agency Inc - 1 Truman Parkway, Suite 101, Annapolis MD 21401 - P 410.222.7858 F 410.222.7881 info@aamentalhealth.org