Provider Forms

For reimbursement, providers are to complete LifeSolutions required forms. Providers may substitute their standard clinical case forms for the optional forms, provided that their forms contain the same basic clinical information.

Required Forms:	Optional Forms:
Affiliate Provider Reimbursement Claim Form Client Case Opening Client Case Closing Consent to Obtain Release Information Notice of Privacy Practices Statement of Understanding Waiver of Referral	Case Activity Notes Intake Sheet LifeSolutions Progress Notes