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Division of Mental Health and Addiction Services
New Jersey Helps
Reach NJ Addiction Help
Council on Mental Health Stigma
New Jersey Mental Health Cares Hotline
National Suicide Prevention Lifeline   Nacional de Prevencion del Suicidio
National Center for Posttraumatic Stress Disorder (PTSD)
New Jersey Housing Resource Center
NJ Family Care
Substance Abuse and Mental Health Services Administration (SAMHSA)
The Peer Recovery Warm Line

Advance Directives (Psychiatric)
Click here to go to the Psychiatric Advance Directives page.


 
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Application for Involuntary Commitment (posted January 2013)
Clinical/Screening Certificate for Involuntary Commitment for Mentally Ill Adults (September 2014)
Temporary Order for Involuntary Commitment to Treatment of an Adult (Outpatient Treatment)
Temporary Order for Involuntary Commitment to Treatment of an Adult (Inpatient Treatment)
Temporary Order for Involuntary Commitment of a Minor
Civil Commitment Order
Clinical Certificate for Involuntary Commitment of Minors 
Request for Parental Admission of a Minor for Seven Days



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Detainer
Detainer Form (posted October 2007)



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Incident Reporting Information and Forms

                                                  NEW !

Administrative Order 2:05 (Effective August 17, 2022)

Administrative Order 2:05 Attachment A - Incident Reporting Levels and Categories (Effective January 18, 2024)

Incident Reporting Power Point Training for Providers (Revised August, 2022)

DHS-DMHAS Provider Training, Investigations and Interviewing (January 2023)

Incident Reporting Training Request Form (New August, 2022)

DMHAS Quality Management Unit Community IRMS contacts (Revised October 3, 2023)

DMHAS Initial Incident Report Form (Effective August, 2022)

Instructions for DMHAS Initial Incident Report Form

Addendum to Initial Incident Report-Additional Consumer or Staff Information (Effective August, 2022)

DMHAS Follow Up Incident Report Form (Effective August, 2022)

Instructions for DMHAS Follow Up Incident Report Form

 

IMPORTANT: Update from Department of Human Services regarding COVID-19 Incident Reporting

 

Effective 6/14/2023, the Department of Human Services’ (DHS) Office of Program Integrity and Accountability (OPIA) has rescinded the 11/15/2022 COVID-19 Incident Reporting guidance.  Service providers rendering services (ex. Residential, Day, Support Coordinators, etc.) to individuals through the below entities are no longer required to report positive COVID-19 test results for individuals served to their respective Division (this includes the Streamlined reporting process) unless it is related to hospitalization or death.  In those instances, established reporting requirements are to be followed. 

  • Division of Developmental Disabilities (DDD) (Please note that this is applicable to Support Coordination Agencies as well);
  • Contracted by the Division of Mental Health and Addiction Services (DMHAS); or
  • Licensed by the New Jersey Department of Health (DOH) to provide mental health or substance use disorder services.

 




 



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Integrated Case Management Services (ICMS)
ICMS Forms:     (
Community)     (Interim)

ICMS Termination Request (October 2011)



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Police Transport and Supervision
Request for Police Transport and Supervision (Outpatient Treatment)
Request for Police Transport and Supervision (Screening Outreach)



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Pre-Admission Screening Resident Review (PASRR)
Categorical Determination Psychiatric Evaluation (revised March, 2015)
Level II Psychiatric Evaluation Form (revised January, 2019)
Level II Psychiatric Evaluation Webinar Training (January 2019)
Instructions for Completing the Revised Level II PASRR Psychiatric Evaluation Form
Resident Review Form



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Quarterly Contract Monitoring Forms (QCMR)
Click here to go to the DMHAS QCMR and Annex A Forms page.



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Residential Termination Form
Supervised Residence Discharge Form  Revised December 8, 2020
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Screening
Clinical/Screening Certificate for Involuntary Commitment for Mentally Ill Adults (September 2014)
Screening Document for Adults (May 2017) 



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State Psychiatric Interfacility Transfers
N.J. DMHAS Letter to Providers
N.J. Department of Health Letter to Healthcare Facility Providers
Instructions
Transfer Form
Inpatient Interfacility Transfer Form



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Unified Services Transaction Forms (USTF)

You can e-mail your USTF data to:   dmhs.ustf@dhs.state.nj.us

Acceptance/Termination
Emergency/Screening
Incoming/Outgoing Client Transfers
Manual
Project Code Listing
Service Area Listing



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Miscellaneous Forms
Agency Referral and Response Form
Metabolic Syndrome Tracking Form
Psychotropic Medication Emergency Certification Form
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