Medicaid Enrollee Resources

Medicaid Member Handbook

Medicaid Meber Handbook- Spanish

Advance Directives
Any adult client who is not incapable 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.

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.
Incident Report and Review form
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

CONTACT US

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