Medicaid Enrollee Resources

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/C62A-15S1004_1800010118000101.pdf

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
Personal History Packet – Adult
Personal History Packet – Youth

Spanish Forms

Authorization for Release of Records and/or Request for Access
Revocation of Auth for Release of Records Spanish
Personal History Packet – Adult
Personal History Packet – Youth

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

CONTACT US

Logan: 435-752-0750
Brigham City: 435-734-9449
Tremonton: 435-257-2168
Rich: 800-620-9949