Client Forms & Instructions

Scroll down for Prevention, Fiscal and Miscellaneous information.

  1. Case Management/Treatment
  2. Prevention
  3. Fiscal
  4. Universal
  1. 01. Admissions Form
  2. 02. Discharge Form
  3. 04. Paperwork Procedures WMS, Residential, Extending, Transfer, DC
  4. 04A. For the Community Based Contracted Providers Procedures to Request Funding for Residential Placement LOC
  5. 05. Request for Service Placement Approval
  6. 06. Consent to Release Information rvsd 08122021
  7. 06A. Consent for Redisclosure rsvd 08122021
  8. 06B. Consent for Multiple Treatment Facilities
  9. 06C. LCDAC Consent for Redisclosure Multiple Tx Facilities
  10. 06D. LCDAC Consent for Lancaster County Treatment Courts
  11. 06E. LCDAC Consent for LCP Pre-Parole and D2D Referrals
  12. 07. Client Rights rvsd 08122021
  13. 08. Complaint Grievance and Appeal Procedure rsvd 08122021
  14. 09. Charitable Choice Disclosure rsvd 08122021
  15. 10. LCDAC GPRA instructions and process rvsd
  16. 10A. LCDAC GPRA Follow Up Acknowledgement Signature Page
  17. 11. Buprenorphine medication paperwork and procedures
  18. 11A. LCDAC Request for Bup Medication form
  19. 11B. LGH Addiction Medicine Emergency Referrals Procedure
  20. 12. Ganse Apothocary and LGH Convenience Pharmacy Paperwork Procedures
  21. 13. Methadone Maintenance Paperwork Procedures to Request Funding Approval_
  22. 14. Continued Stay Request (002)
  23. 15. Request for MAT Funding Approval Outpatient-Inpatient