Anbieterformulare

State Opioid Response Fund

• SOR-IV-SUPRT Resources
• SUPRT-A survey
• SUPRT-C survey
• Email SOR form questions to sor.gpra@greenbush.org

Verwaltungsformulare

• Brief Client Clinical Update
• Multi-party release
• Member Release of Information Updated 2023

Berufungsformulare

• Kansas Administrative Appeal Form (Englisch)
• Kansas Administrative Appeal Form (Spanisch)
• Kansas IOP Appeal Form (Englisch)
• Kansas IOP Appeal Form (Spanisch)
• Kansas RTC Berufungsformular (Englisch)
• Kansas RTC Berufungsformular (Spanisch)

Problem Glücksspiel

Problem Gambling Forms are a part of the Carelon member registration process in Availity. The forms below are for REFERENCE ONLY. Please see the Kansas Specific Training Documents for the Availity Powerpoints related to Gambling processes.

• Kansas Problem Gambling Discharge Form
• Kansas Problem Gambling Concurrent Form
• Kansas Problem Gambling Intake Form
• Kansas Problem Gambling RTC-Antragsformular
• Kansas Problem Gambling VEP Exit-Formular

Note: Beginning in September 2025 problem gambling forms will be available as part of the member registration process in Availity.  Navigate to the Availity login portal to complete Problem Gambling forms.