Mental Health Provider

The ICD-10 Prioritized List can be found at the following webpage:

A searchable version of the Prioritized List of Health Services is available here.

Mental health reporting forms

Complaint forms for OHP and non-OHP members are located on the Get Informed page. Forms in additional languages are available upon request.

Mental health provider contract exhibit forms (used by providers operating with a Multnomah MHASD Cost Reimbursement Contract)

Mental health treatment request forms

Directions are as follows for this Psychological Testing Authorization Request (PTAR) Form:

To request psychological evaluations, please complete a (PTAR) form and submit supporting clinical documentation. The following information should be included for the request to be considered for review:
     1. PTAR with completed supplemental questions. 
     2. Mental Health Assessment (within last 60 days); updated treatment plan and needs.
     3. Submit any additional clinical justification and documentation to support request for authorization. 

*Neuropsychological Assessments or assessments related to medical conditions are the responsibility of member's capitated medical plan and requests must be made through medical insurance not behavioral/mental health. 

Please submit complete requests to Multnomah Mental Health Utilization Review by secure email to or by fax to 503-988-3137.

State and Health Share / Multnomah Mental Health Contracts