Provider Forms

Administrative Forms

• Brief Client Clinical Update
• Member Release of Information Updated 2023
• Sample Multiparty Release
• W-9 (Editable Version)
• KDADS SUD request form and Instructions

Appeals Forms

• Kansas Administrative Appeal Form (English)
• Kansas Administrative Appeal Form (Spanish)
• Kansas IOP Appeal Form (English)
• Kansas IOP Appeal Form (Spanish)
• Kansas RTC Appeal Form (English)
• Kansas RTC Appeal Form (Spanish)

Problem Gambling

• Problem Gambling Provider Guide (Updated 03-19-19)
• Kansas Problem Gambling Concurrent Form
• Kansas Problem Gambling Discharge Form
• Kansas Problem Gambling Intake Form
• Kansas Problem Gambling RTC Request Form
• Kansas Problem Gambling VEP Exit Form

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.