Provider Forms HIPAA/Privacy Practice Notice Trifold GOSH Billing Authorization Disclosure GOSH Enrollment Form Richland CAP GOSH Residency Verification Form (RVF) GOSH Staff Disclosure of Information Benefits Plan Brochure Comprehensive Richland CAP Approval SFY2027 Intent to Purchase DocumentsIf you need an emailed version of this form, please contact Carey Vogt at 419-774-5811. Please Read First: Application Process for SFY2027 Funding Application Instructions for FY2027 Detail Program Description for FY2027 Budget Requirements for FY2027 Marijuana Attestation RCMHRS Marijuana Attestation Agency Agreement FY2027 MHA UCR FY2027 Service Projection Form Template FY2027 MHA 052 Certificate Regarding Debarment, Suspension and Other Responsibility Matters Primary Covered Transactions Benefit Plan Brochure FY2027 Request for Funding Application Checklist
