Facility-Based Treatment | Companion Benefit Alternatives Form Resource Center

Facility-Based Treatment

Choose a Form

Facility-Based Treatment Form

Use this form to request certification for both mental health and substance use disorder treatment for inpatient, residential treatment (RTC), partial hospitalization (PHP), intensive outpatient (IOP) or outpatient electroconvulsive therapy services.
Discharge Form

Use this form to inform CBA when a patient is being discharged from an inpatient or residential treatment center (RTC).