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 SFY2025 Intent to Purchase DocumentsIf you need an editable version of this form please contact Sherry Branham at 419-774-5811. Please Read First: Application Process for SFY2025 Funding Application Instructions for FY2025 Detail Program Description for FY2025 Budget Requirements for FY2025 Marijuana Attestation RCMHRS Marijuana Attestation Agency Agreement FY2025 MHA UCR FY2025 MHA 052 FY2025 Service Projection Form Template Certificate Regarding Debarment, Suspension and Other Responsibility Matters Primary Covered Transactions Benefit Plan Brochure FY2025 Request for Funding Application Checklist
