Application for Licensure Under COMAR 10.63 Application (revised 10/2020)
MDH Provider 440 - Instructions Providers - Please use the following forms to submit 440s to the AACMHA:
2012 Reconciliation Instructions
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
Death Notice BHA Death Notice Form
Advance Directive for Mental Health Treatment Advance Directive
Please click here for MOA.
Rev. March 2, 2021
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 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