Case Closure and Transfer Form (Outpatient and Case Management Providers Only)

Death Reporting Form

Discharge/Termination/Transfer Form

Notice and Hearing Rights - Medicaid Recipients

Notice and Hearing Rights - Non-Medicaid Recipients

Privacy Notice Form (Brochure Formatted)

Residential Occupancy Report and Invoice (Form 3806)

Suspected Violation of Recipient Rights - Complaint Form (PDF Format)

Suspected Violation of Recipient Rights - Complaint Form (MS Word Format)

Utilization Management/Review Form - Case Management

 Your Rights When Receiving Mental Health Services in Michigan (Booklet)
        (Spanish Version)        (Arabic Version)

Access Alliance of Michigan
A Division of Bay-Arenac Behavioral Health
5455 Hampton Place
Saginaw, MI 48604
989-497-1302

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Last Update: 10/11/07