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FORMS

MDH Budget Forms
Standard MDH Budget Forms are available on the following website (includes MDH 432, 433, 434, 436, etc)
http://health.maryland.gov/Pages/sf_gacct.aspx

MDH Provider 440 - Instructions
Providers - Please use the following forms to submit 440s to the AACMHA:
2012 Reconcilation Instructions
440 Form
440A Excel Sheet

Electronic Billing Forms
APS Healthcare new ASO, effective October 1st
www.apshealthcare.com

Grievance Form
Grievance Form (pdf, 31 KB)

Petition for Emergency Evaluation
Petition for Emergency Evaluation (pdf, 42 KB)

Residential Rehabilitation Program Application Form  Downloadable Application Form: CLICK

Release of Medical Information Authorization:  Downloadable Form:  CLICK

 

AACMHA Procurement Manual (updated 3-3-11)
PROCUREMENT-MANUAL3-3-11 (pdf, 13.34 MB)

Assertive Community Treatment Services (ACT) for Adults with Mental Illness in Anne Arundel and Prince George's Counties
ACT REFERRAL & CONSENT FORMS (doc, 40 KB)

Consultant Invoice Form
generalBook3 (xls, 30 KB)

Death notice
deathreportingjpg_1
deathreportingjpg_2
deathreportingjpg_3
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PMHS Non-Medicaid Eligibility Criteria
Memo (pdf, 21 KB)
Eligibility Criteria (doc, 48 KB)
Decision Tree (doc, 79 kB)

Advance Directive for Mental Health Treatment
advancedirective.pdf (pdf, 119 KB)

 

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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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