This is the Magellan website for behavioral health providers
Magellan Health

Clinical Forms

In support of our commitment to quality care, we require our providers to maintain organized, well-documented member treatment records that reflect continuity of care. We expect providers to document all aspects of treatment in a timely manner, including face-to-face encounters, telephone contacts, clinical findings and interventions.

NOTE: Forms may not be compliant with some state regulations. It is the provider's responsibility to ensure that his/her documentation is compliant with all applicable state laws.

Treatment Record

This Treatment Record Review tool (PDF) is not required in the member's file; however, it is is used by Magellan reviewers when evaluating treatment records during a site visit and is posted for reference purposes only. For more information on treatment record reviews and site visits, please see the Magellan Provider Handbook (PDF).

Authorization to Disclose PHI to PCP

This is a sample Authorization to Disclose PHI to PCP form (PDF) that enables the behavioral health provider to share protected health information (PHI) with the primary care physician (PCP). The provider is encouraged to have each member sign and date the form at the outset of new episodes of care.

Clinician Communication Form

A completed Clinician Communication Form (PDF) allows the behavioral health provider to inform the PCP that behavioral health treatment is occurring, and also provides information on how to contact the behavioral health provider if needed. Other information in the communication can include member diagnosis, a clinical summary, treatment plan changes, member safety issues, laboratory tests ordered, and medication issues or changes.

Member Rights and Responsibilities

Review the rights and responsibilities statement with the member at his or her first appointment; then sign and have the member sign, and retain a copy in the member's record.

Psychological Testing Request Form

Complete this form to request authorization for psychological testing. In most cases, an initial assessment by a behavioral healthcare provider must be administered before psychological testing is authorized. To avoid potential issues with reimbursement, do not initiate psychological testing until an authorization has been received.

ABA Forms

For autism-related forms, sign in to this website. From the Resources section, select State & Plan Information, then choose Autism-Specific Information.

Auxiliary Forms (use as needed)

Substance Abuse/Chemical Dependency Assessment (PDF)
If your assessment or the result of the chemical dependency (CD) screening indicates a possible CD issue, the Substance Abuse/Chemical Dependency Assessment form must be completed. This form documents that you have conducted a CD assessment.

Depression Screening (PDF)
This optional tool can be used to assist in the assessment of client depression.

Plan- or State-Specific Forms

Refer to the plan- and state-specific pages of this website.