Outpatient Substance Use Disorder Treatment | Companion Benefit Alternatives Form Resource Center

Outpatient Substance Use Disorder Treatment

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Outpatient Substance Use Disorder Treatment Request

Use this form to request certification for outpatient substance use disorder (SUD) treatment services (e.g. individual or group therapy). Do not use this form for mental health treatment requests, intensive outpatient programs (IOP) or partial hospitalization programs (PHP).