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Forms

Behavioral Health & Developmental Services Forms

Administrative Review Policy
Administrative Review Request Form
Adult Need Assessment Process
Adult Need Assessment Form
CASSP Community Team Referral Form
CCRI Base Application Form
CCRI County Attestation Form
CCRI Enrollment Short Form
CCRI Provider Closure Form
Critical Incident Flowchart
Critical Incident Form
Critical Incident Instructions (Non- HCSIS)
Critical Incident Policy & Procedures
Death Report Form
Follow-up Form
HCSIS Reporting Procedures
OMHSAS Provider Enrollment Letter
Partial Provider Resource Directory
Root Cause Analysis (RCA) Form
Root Cause Analysis (RCA) Policy
STAR (Service Team for Adults in Recovery) Referral Form
STAR (Service Team for Adults in Recovery) Release Authorization


Family Based MH Forms


Family-Based Resource Directory
Beacon Recommendation Letter
Family-Based Review Precertification Form
Family-Based Notification Form

IBHS Forms

Child Family Center Brochure
IBHS Provider Listing
IBHS Referral and Release
Westmoreland County Letter
  1. Staff Responsibilities-Adults
  2. Staff Responsibilities-Children
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  10. Veterans Information
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Westmoreland County BH/DS

  1. 40 N Pennsylvania Ave
    Greensburg, PA 15601

    Ph: (724) 830-3617

  1. Case Management & Support     (800) 353-6467
    24 Hour Crisis Hotline (800) 836-6010
    Health Choices Managed Care (877) 688-5977
    Emergency Behavioral Health (EBH) Team (formerly DCORT) (724) 830-3617

  1. COMPASS 
    MHA 
    ODP
    OMHSAS  
    Ray of Hope (Suicide Prevention)
    Support Groups Link
    WCSI
    Crisis Response Center
    Beacon Health Options
    Site Map

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