- 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
Contract Exhibit Forms
For providers who have a Multnomah County Mental Health & Addiction Services Division cost reimbursement contract:
To request an Excel version, email firstname.lastname@example.org
Mental Health Treatment Request Forms
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 the following:
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.
Submit your request to Multnomah Mental Health Utilization Review by secure email to URTeam@multco.us or by fax, 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 Health Share/Multnomah Mental Health Contracts