Get Ok Letter Of Collaboration 2013-2025

Filling out the OK Letter Of Collaboration is an important step for facilitating cooperation between two facilities in providing services to a shared member. This guide will help you navigate the form with clear instructions on completing each part accurately.

Follow the steps to successfully complete the OK Letter Of Collaboration form

1. Press the ‘Get Form’ button to access the document and open it in your editing tool.
2. In the first section, enter the names of the two collaborating facilities. Replace the placeholders with 'Facility A' and 'Facility B' accordingly.
3. Next, provide the name of the service recipient in the designated space. Ensure this is accurate as it is crucial for identifying who will receive the services.
4. Fill in the recipient's ID number in the specified field right after their name. This number will help track their services.
5. In the next section, detail the names and credentials of the licensed behavioral health professionals (LBHPs) from both facilities. Each clinician should sign the document to confirm their agreement to collaborate.
6. The service recipient, if 14 years or older, must sign the form to indicate their agreement with the treatment approach. They should also date their signature.
7. If applicable, the parent or guardian must sign and provide their relationship to the member along with the date.
8. Enter the division of the monthly dollar rate allocated to each facility. Ensure the amounts do not exceed the limits set by the CAR/ASI/TASI scores.
9. In the final section, list the types of services to be provided by each facility, ensuring to match the services with the facilities involved.
10. Once completed, review the form for accuracy. You may then save any changes, download, print, or share the form as needed.

Complete the OK Letter Of Collaboration form online today to ensure collaborative services for the member.