Home   |    Contact Us   |    Frequently Asked Questions   |    Search   |    Site Map
FORMS

Application for Licensure Under COMAR 10.63 Application (revised 10/2020)

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

Optum Maryland Provider Forms

Grievance Form Grievance Form

Petition for Emergency Evaluation Part 1 Part 2

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.

Rev. March 2, 2021

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's Crisis Line
Dial 2-1-1, Press 1
24 hours a day, 7 days a week

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

Anne Arundel County Veteran's Service Phone Line
410-222-3500
8:00 AM - 4:30 PM, Monday-Friday

National Suicide Prevention Hotlines

National Suicide and Crisis Lifeline
Dial or Text 988 or Chat
24 hours a day, 7 days a week

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

Physician Support Line
1-888-409-0141
Monday – Friday: 8AM - 3AM ET
Saturday – Sunday: 8AM - 3AM ET

Veteran's Crisis Line
1-800-273-8255, Press 1, or text to 838255
24 hours a day, 7 days a week

Anne Arundel County Department of Health's Gun Violence Intervention Team  (GVIT) Suicide Prevention Toolkit

Anne Arundel County Department of Health's Gun Violence Intervention Team (GVIT) Domestic Violence Toolkit

Anne Arundel County Department of Health's Gun Violence Intervention Team (GVIT) Responsible Gun Ownership Toolkit

Anne Arundel County Department of Health’s Gun Violence Intervention Team (GVIT) Youth Gun Safety Toolkit

More Information 

Grievances/Appeals

RFP/RFI

Donate

Employment Opportunities

Contact Us

Programs/Services 

Adults

Children and Adolescents

Elderly

Housing

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 Email aac-lbha-connect@aacounty.org