Wicomico Behavioral Health Authority Form Center
PRMC 24 hour hotline: 410-543-7160
Hours of Operation: Monday - Friday - 8:00 AM - 5:00 PM
Providing resources, access, and information to consumers of the Maryland Public Behavioral Health System.
- NEW! 2019 Behavioral Health Resource Guide
- Online Resource Database for Children and Youth with Special Health Care Needs
- The Schapiro Training and Employment Program
Consumer Support Form– to be used for residents of Wicomico County that are active members in the Public Behavioral Health System (PBHS) and need assistance with mental health medications, mental health laboratory tests, and/or special needs such as security deposit, past due rent or utilities.
Individual’s Authorization Form – The Wicomico Behavioral Health Authority requires an Individual’s Authorization form to be completed for all agencies/businesses that we may need to contact to assist the consumer such as his/her mental health provider, landlord, pharmacy, and/or other agencies that will need proof of assistance.
Targeted Case Management Referral Form– to be completed to request Targeted Case Management services for residents of Wicomico County.
Residential Rehabilitation Services Application – to be completed by a mental health provider to request services.
Public Assistance to Adults Disability Certification Form – to be completed for all those being considered for the Residential Rehabilitation Program.
Homeless Identification and Birth Certificate Project – to be completed by a mental health provider or social service organization.
Youth Care Coordination Referral Form – to be completed to request Youth Care Coordination services for residents of Wicomico County.
- BEACON HEALTH OPTIONS – PROVIDER FORMS
- Accreditation-Based Licensure Application Process
- Guidelines for One Time only Accreditation Assistance
- Licensure Application-Community Based Behavioral Health Programs & Services
- Agreement to Cooperate
- Children’s Choices Respite and PRP Referral
- Uninsured Registration Request
- Targeted Case Management Plus Referral
- TCM 1915i Care Coordination
- TCM Customized Goods
- TCM Q &A
- Maryland Coalition of Families