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Mental Health and Disability Services
General
Information
MH/MR
Management Plan (06/2007)
2007-2008
Federal Poverty Guidelines (10/2009)
2007-2009
Three Year Strategic Plan (03/2009)
2006
Annual Review (12/2008)
Appeals
Process (06/2009)
HIPAA Notice
of Privacy Practices (07/2009)
Brochures
General Brochure (11/2009)
Transition/Intake
Brochure (11/2009)
General Forms
CPC Application
CPC
Application Update
Authorization
to Obtain and/or Disclose Information(11/2009)
Provider Forms
Quick
Reference Instructions for Washington County Forms (11/2009)
Provider
Information for the Washington County Forms (11/2009)
Legal
Settlement Form
Acknowledgement
and Consent of NPP Form (07/2009)
Provider/Payee
Form
Service
Request Form (11/2009)
Funding
Agreement Form
Hourly Budget
Detail Form
Site
Budget Detail Instructions
Site
Budget Detail Form
Links
Hillcrest
Family Services
WCDC/AES
ResCare
Systems Unlimited
REM-IOWA,
Inc
Southeast Iowa
Case Management
Iowa Vocational
Rehabilitation Services
Department of Human
Services
Orchard Hill Complex Building #4
PO Box 902 - 2175 Lexington Boulevard-A
Washington, Iowa 52353
Telephone:
(319) 653-7751
Fax: (319) 863-1710
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