As part of our regional shared services, the CWHP has developed several regional CCS forms.  Individual CWHP counties may modify the forms to meet their specific needs. 

​Email Lori at lori.martin@cwhpartnership.org to request the unlocked documents. 

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• CCS Consumer Handbook (updated 11/16/18) - a resource for Consumers who are referred to CCS. The document can be used "as is" or can be customized to the individual county's CCS program.

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• CCS Provider Contract Addendum (6/29/21)  outlines regional expectations for contracting with CCS providers

 

• Internal File / Process Review Checklist (updated 1/11/18)

 

• Referral Form (updated 7-27-17)

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• Application and Admission Agreement (updated 7-27-17)

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• Physician Prescription (updated 1-11-18)

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• Determination of Need (updated 9-16-19)

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Assessment Tools.  Following are 3 sets of CCS assessment tools that CWHP counties may chose to use and/or adapt:

• Narrative Assessment (6-30-21)
• Companion Document (6-30-21)
• CCS Comprehensive Assessment Summary (June 2021)
• (original) Comprehensive Assessment (updated 9-16-19)
  • ​Assessment Summary  (updated 10-19-19)
  • Life Satisfaction Scale - optional
  • Assessment Addendum - optional

           

Additional Assessment Resources:​

• Evidence-Based AODA Screen Tools

• Medicaid Mental Health and Substance Abuse Documentation Requirements

• ​Recovery Plan  (updated 2-4-21)

  • Recovery Plan Addendum - optional

• ​Recovery Plan Supplement - Goals 3 through 6

• Marquette County's Individual Service Plan for CLTS and CCS (please note: this plan has been approved for use by Marquette County; other counties interested in utilizing this tool would have to go through he CLTS approval process)

• CCS Discharge Summary (4-22-16)

• TARP Progress Note

Additional Optional Tools

• ​Sample Service Facilitator Checklist (30 day, 6 month, 1 year)

• Sample Standard Language for Recovery Plans

• Service Array Summary (updated 6-25-18)

• Service Facilitator Service Plan meeting note template

• TARP Note Review Guide

• Provider Rate Setting Tool

  • video: ​Billing and Rate Setting​​

  • video: Overview of the Sample Rate Setting Tool

• Roles of CCS Staff Members

• Regional Toolkit

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