Forms and Manuals

The forms below are provided as Word files for download.

Screening, Triage and Referral Interview and Registration Form (417k doc)
Guilford Center Operations Manual (917k PDF)
The Guilford Center Admission Form - REVISED 5-07 (122k dot)
Authorization Request Form - REVISED 7-06 (156k dot)
Discharge Summary/Aftercare Plan - REVISED 4-08 (333k dot)
Fee Setting & Insurance Information (80k dot)
December 2006 Memo on Sliding Scale Fees (85K pdf)
The Guilford Center's 2007 Sliding Scale Fee Schedule (71k html doc)
Outpatient Provider Questionnaire (80k dot)
Service Location Registration Form (307k dot)

Care Management Enrollment Form (116k dot)

Introductory Person Centered Plan Form (200k doc)
Complete Person Centered Plan Form (488k doc)
Person Centered Plan Admission Form (electronic - 30 k doc)
Person Centered Plan Admission Form (print form - 207k doc)

Revised Service Records Manual on the State DHHS Web site

NEW! IPRS Target Population Form - REVISED 5-07 (149k dot)

IPRS Target Population
IPRS Target Populations Details provide information on all effective IPRS Target Populations Groups. All Target Groups are included, along with specific client eligibility criteria, restrictions, valid diagnosis, Utilization Management requirements, funding sources, services supported by the population group, and concurrency rules.

This information is being furnished to help clarify your understanding of target pop groups, their specific requirements and effect on claims.
Adult Developmental Disabilities (152k PDF)
Adult Mental Health (204k PDF)
Adult Substance Abuse (228k PDF)
Child Developmental Disability (128k PDF)
Child Mental Health (256k PDF)
Child Substance Abuse (216k PDF)