Information for Providers

Policies and Procedures

Most policies and procedures for BHRD can be found in the Provider Manual (see below).

Information management system policies and procedures are not located in the Provider Manual, and can be found by following the links below.

• Attachment A: Summary of Attributes
• Attachment B: Data Dictionary
• Attachment C: HIPAA Trading Partner Agreement
• Attachment D: Provider Trading Partner Agreement 837P

Please direct any questions or requests to JanRose.OttawayMartin@kingcounty.gov

Forms

• SUD residential treatment authorization request cover sheet
• Consent for substance use disorder client lookup
• Authorization for disclosure and use of substance use disorder protected health information
• Authorization to disclose and redisclose substance use disorder protected health information

DCFS/Children’s Administration Forms

• DCFS Children’s Administration/BHRD Memorandum of Agreement
• DCFS Children’s Administration Individual Referral Form
• DCFS Children’s Administration (CA) Referral & Treatment Process
• Substance Use Disorder Referral Form