Resources & Additional Help

 

Telehealth Mental Health Services:

In order to be seen via HIPAA compliant method of live, two-way interaction between the client and provider using audio-visual technology or phone call for the delivery of mental health services to and from remote locations, this Consent needs to be signed and returned to Southern Minnesota Behavioral Health prior to the first session.

• Informed Consent for Telemental Health Services
• Emergency Contact Form 
• Referral Form
• HIPAA Notice of Privacy

MNSURE information: 

Coronavirus (COVID-19) emergency special enrollment period: open to eligible Minnesotans who do not have health insurance. MNsure is Minnesota’s health insurance marketplace where you can shop, compare and choose health insurance coverage that meets your needs. Southern Minnesota Behavioral Health has certified MNsure navigators on our staff who can assist you in the process.  Please call to schedule a time to talk with one of our MNsure navigators, which we will happily do via telephone or video conference call. 

• MNSure Link

Requesting Records: 

For the release of records, there needs to be both a release and a request.  Releases need to be signed by the client, in person at one of our five offices so they can be verified by one of our staff. Likewise, if you are requesting your own records, paperwork needs to be filled out in person at one of our five office locations. If there is a release on file, other entities may us the paperwork below to fax a request for records to 507-354-3183.

• Request For Medical Records
• Request by Client or Legal Representative to Access Medical Record
• Consent for the Release of Information

Intake Packets for Initial Appointment:

• Payment for Services Client Consent Form
• Consent for Treatment
• Child Questionnaire
• Adult Questionnaire
• Strengths and Difficulties Questionnaire 4-10 
• Strengths and Difficulties Questionnaire 11-17 
• Strengths and Difficulties Questionnaire P11-17
• Payment for Services Spanish Consent Form

Critical Links to Explore:

• National Alliance on Mental Illness 
• Yellow Ribbon Suicide Prevention Center
• American Psychological Association 
• Mental Health for Military
• Post Traumatic Stress Disorder
• Substance Abuse & Mental Health Services Administration
• National Institute of Mental Health