Forms and Applications Addictive & Mental Disorders Division Forms and Applications Text/HTML The DPHHS website is being redesigned and will be moved to a new platform in July. Please be aware that some bookmarks to the DPHHS site may need to be updated after the move. Thank you for your patience while we complete this move. Medicaid Enrollment Application form for WASP and MHSP Clinical Eligibility Form for WASP and MHSP Applicant Checklist for WASP and MHSP 72-Hr Crisis Stabilization Form Crisis Intervention and Response Form Mental Health Forms: Clinical Prior Authorization Form Continued Stay Form Serious Disabling Mental Illness (SDMI) and Level of Impairment Worksheet Daily Limit Request Addictive and Mental Disorders Division Data Corrections Request Substance Use Disorder (SUD) Forms: Substance Use Disorder (SUD) Prior Authorization Request Form for Residential and Inpatient Services Substance Use Disorder (SUD) Continued Stay Request Form for Residential and Inpatient Services