Behavioral Health Forms

Special consent required under federal law (42 CFR Part 2) for disclosure of substance use disorder treatment records. More restrictive than standard HIPAA authorization. Requires specific elements including prohibition on re-disclosure.

Detailed evaluation of an individual meeting criteria for court-ordered treatment (danger to self, danger to others, persistently/acutely disabled, gravely disabled). Requires two behavioral health professionals.

Complaint to DOL Employee Benefits Security Administration about employer-sponsored plan violations of mental health parity requirements under the MHPAEA.

Florida-specific involuntary examination petition under the Baker Act. Allows 72-hour hold for psychiatric evaluation when a person meets criteria for involuntary examination.

Written appeal documenting how a denial violates the Mental Health Parity and Addiction Equity Act (MHPAEA). Appeals with specific parity violation documentation have significantly higher approval rates.

Request for insurer to disclose how it applies parity requirements: comparing treatment limits, medical necessity criteria, and non-quantitative treatment limitations (NQTLs) between mental health/substance use and medical/surgical benefits.

Petition for involuntary inpatient or outpatient treatment after evaluation confirms that the individual meets criteria for court-ordered care. Filed by treatment provider, family member, or state attorney.

Legal petition for involuntary psychiatric examination of a person believed to meet criteria for danger to self/others or grave disability. Known by different names: Baker Act (FL), 5150 (CA), Section 12 (MA), and other state-specific designations.

Prior authorization for inpatient detox, residential treatment, intensive outpatient (IOP), or medication-assisted treatment (MAT). Subject to MHPAEA parity requirements.