24 Hour Crisis Line

National Suicide Prevention Lifeline:
800-273-8255

 

 

Bear River Mental Health Services Accessible Site

 

 

Medicaid Enrollee Information

This information is available in paper form, free of charge, upon request.  Allow five business days.

NOTE: Links on this page open a PDF document and may require a separate program

Bear River Mental Health Provider Directory

Medicaid Member Handbook

Medicaid Member Handbook- Spanish

Advance Directives
Any adult client who is capable has the right to make a declaration of preferences or instructions regarding their mental health treatment. An Advance Directive is a declaration that allows, or disallows, mental health treatment. You can find an example of an Advance Directive form at https://le.utah.gov/xcode/Title62A/Chapter15/62A-15-S1004.html

English Forms
Authorization for Release of Records and/or Request for Access
Form used to authorize BRMH to give out health information and/or receive information from another agency/person. Also for use by BRMH clients requesting access to their own health information or for use by personal representatives.
Revocation of Auth for Release of Records - Request for Access

Admission Paperwork
Client Admission Form
This form can be filled out electronically and then printed out to bring in or it can be printed blank and then filled out by hand.
Personal History Packet – Adult
Personal History Packet – Youth

Spanish Forms
Authorization for Release of Records and/or Request for Access
Client Admission Form
Puede completar este formulario electrónicamente, o imprimirlo y completarlo a mano, y luego llevarlo a la oficina.
Revocation of Auth for Release of Records Spanish
Personal History Packet – Adult
Personal History Packet – Youth