Forms and Applications Addictive & Mental Disorders Division Forms and Applications 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 Out of State Adult Acute Behavioral Health Inpatient Hospital 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: SUD Prior Authorization SUD Continued Stay Addictive and Mental Disorders Division Data Corrections Request