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Provider Forms
Click on the links to open the forms.
All the forms will be in pdf format unless otherwise stated.
Critical Incident Provider Report Form 02/20/08
OP Instructions 06/01/06
Request for NeuroPsychological and Psychological Testing 07/15/08
Substance Abuse Outpatient Registration Form 02/20/08
Mental Health Outpatient Registration Form 02/20/08
* Gateway Health Plan
®
at a Glance for Behavioral Health Services
* This document provides quick reference to instruction for authorization as well as critical phone numbers. It also includes detailed instruction for Providers to confirm membership in the Gateway
Medicare Assured
®
Plan.
