TMH Forms
TMH Financial Policy
This document states the policies related to the regulation, supervision, and oversight of the financial and payment systems.
Patient Rights & Responsibilities
A patient has the right to privacy with respect to his or her medical condition. A patient's care and treatment will be discussed only with those who need to know.
IM+CANS AUTHORIZATION FORM
This document authorizes The Illinois Department of Healthcare and Family Services to provide information to TMH Behavioral Services regarding any prior IM+CANS documentation to ensure clients receive consistent and coordinated healthcare services.
**For question #4 please date it 5 years out from the signing date.
ROI Form
Release of Information (ROI) is a document that allows our clients to authorize TMH to share their protected health information (PHI) with a third party. It grants permission for specific types of information, such as medical records, or other health-related data, to be disclosed for specific purposes.
IM+CANS & Individual Treatment Plan Review Acknowledgement Form
This HIPAA-compliant form is used to document that clients (age 12 and older) and/or their parent or guardian have reviewed and understand the IM+CANS assessment and Individual Treatment Plan with their therapist. It ensures informed participation in treatment planning, supports clinical transparency, and provides formal acknowledgment through required signatures from the client, guardian (if applicable), therapist, and LPHA.