(973) 770-5505
info@cpcmo.org

Forms and Information

Accessing Services

If you need information on how to access our services, please go to: Accessing Services.

Family Handbook

  • Describes the process, values, policies and procedures of Wraparound and Care Management with Caring Partners.

Family Support Organization Brochure

  • A brief description of the Family Support Organization.

Grievance and Appeals Policy Notice

  • The process when there are challenges with your Care Manager.

HIPAA Privacy Notice

  • An overview of Health Insurance Portability and Accountability Act (HIPAA) and HITECH and how we safeguard and use your information.

"What is HIPAA" Brochure

  • The rights of individuals and CMO’s use of HIPAA

Third Party Liability Letter

  • Information on why CMO requests insurance information for services.

Links to Forms**For enrolled youth only**

Links and descriptions are provided here but these do not need to be completed unless you have been asked to complete the form by a staff member.

Caring Partners Publicity Consent and Release **For enrolled youth only**

  • Release for families to opt in using their images/artwork/writing, etc. for educational purposes, brochures, newsletters, etc. by the CMO.

Caring Partners Initial Packet **For enrolled youth only**

  • Consents for Care Management, electronic communication, transport, and general information.

Caring Partners Release **For enrolled youth only**

  • Release for mental health information to speak with other parties important for the Care Manager to speak with.

Caring Partners Screening for MAID Benefits **For enrolled youth only**

  • Information to determine if family is eligible for Medicaid.

Collecting Documents

  • A form that allows the family to upload supporting documents such as documents needed for Medicaid: birth certificate, social security card, income verification documents, etc., or documents needed for care coordination: evaluations or Individualized Education Plans.

If you would like a copy of the youth’s record, you can use this form to request this information:

Request for Access to PHI **For enrolled youth only**

  • A form that allows the family/youth to request mental health records from the Care Management Organization including individual service plans, and Strength & Needs assessments.

If you would like to fill out a Feedback Form that will go to the Director of Quality and Compliance, click on the link below:

Family Feedback Form **For enrolled youth only**

A form that allows the family/youth to give feedback on Caring Partners.