Resources
- ICD-10 Prioritized List
- Prioritized List of Health Services (searchable)
- Clinical Guidelines
- Regional Behavioral Health System Provider Manual
- Health Share of Oregon Provider Authorization Guides and Forms
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School Transition Protocol Packet 2.2017
(199.53 KB)
Reporting Forms
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Critical Incident Report form
(380 KB)
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Complaint Forms
For Oregon Health Plan members and non-members»
Contract Exhibit Forms
For providers who have a Multnomah County Mental Health & Addiction Services Division cost reimbursement contract:
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Invoice Template Contract Exhibit 6A
(69.36 KB)
To request an Excel version, email mhasd.businessops@multco.us
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Mental Health Treatment Request Forms
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Psychological Testing Authorization Request (PTAR) form instructions
To request a psychological evaluation, please complete a PTAR form and submit supporting clinical documentation. You must include:
- PTAR form with completed supplemental questions
- Mental health assessment (within last 60 days)
- Updated treatment plan and needs
- Submit any additional clinical justification and documentation to support request for authorization.
Submit your request to Multnomah Mental Health Utilization Review by secure email to URTeam@multco.us or fax to 503-988-3137.
*Neuropsychological assessments or assessments related to medical conditions are the responsibility of member's capitated medical plan. Requests must be made through the patient's medical insurance, not behavioral/mental health.
State and County Contracts
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2022 Choice Agreement
(1.16 MB)