Single Point of Accountability (SPA) Forms
Glade Run Services
Blended Case Management (BCM) Referral Form
Glade Run BCM Information
Glade Run Release of Mental Health Information
Staunton Clinic
Allegheny County Blended Service Coordination – Adult Referral Form
Allegheny County Blended Service Coordination – Child Referral Form
Beaver County Blended Service Coordination – Adult Referral Form
Beaver County Blended Service Coordination – Child Referral Form
HVHS (Staunton Clinic) HIPAA Authorization
BCBH Direct Services Unit (DSU)
Blended Case Management (BCM) Referral Form
Authorization for Use or Disclosure of Protected Health Information (PDF)
Authorization for Use or Disclosure of Protected Health Information (MS Word)
Merakey (formerly NHS)
Adolescent BCM Referral Form
Adult BCM Referral Form
D&A Case Management Referral Form
F/ACT Referral Form
Merakey HIPAA Authorization
Additional Forms
Smith’s PCH RESPITE
BCBH Authorization Request Form
Pressley Ridge
Pressley Ridge HIPAA Authorization
Warmline of Beaver County – MHA in Beaver County
The Warmline of Beaver County is a call-in service providing peer support to individuals with mental illness, their families, and friends. Anyone calling the Warmline will have someone to talk to and have the opportunity to discuss problems and access resources.
Local: 724.775.9507
Toll-Free: 877.775.WARM (9276)
Hours: 365 days per year from 6 p.m. to 9 p.m., including holidays
Warmline Peers – Permission to Contact
Mental Health Association (MHA)
Need a partner in health and recovery? Specialized therapeutic interactions are delivered by Certified Peer Specialists (CPS) who are trained to support individuals in their recovery and involvement in the community.
You will need both a Doctor’s Recommendation Form and an Application for Peer Support to apply. A recent Psychiatric Evaluation is necessary as well, as it speeds up the intake process.
Call 724.775.9507 if you have any questions.
Doctor’s Recommendation for Peer Support Services
Application for Peer Support