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Mental Health

Mental Health Provider Resources

The forms, documents and information on this page is used by mental health care providers.

Information Technology
Need help with VPN, LOCUS or SSIS? Email

If you have a new staff member who needs access to VPN and SSIS, email the completed Information Systems Security Policy Form and Contract Case Management Staffing Form to

Committee meets 2nd & 4th Tuesday of every month. GuardianshipConservatorshipInformationSheet.pdfInformation Sheet
Schedule time with Chelly Dufour.

Forms Needed:
Conservatorship/Guardianship Referral Form
Physician's Support Statement

AdultServicesPhoneList.pdfAdult Services Phone List
Case Management Authorization 
Client Data Change Form
Diagnostic Assessment
Interpreter Provider Listing
Physical Location Change Form
Purchase Of Service Form
Workgroup Change Form
InterpreterVerification.docInterpreter Verification
ConsultationResources.pdfConsultation Resources
InHouseTargetedCaseManagementCriteria.pdfIn-House Targeted Case Management Criteria
ClientFlowChart.pdfClient Flow Chart
CorrectionsCollaborativeReferralForm.docxCorrections Collaborative Referral Form
ClientRelationsSpecialistReferral.dotClient Relations Specialist Referral

Preferred Integrated Network (PIN)
PCA Assessment Request Form
PIN Disenrollment Form
PIN SNBC Medica Member Checklist
PIN SNBC Health Risk Assessment
Universal Transfer Form

Recovery Model of Services
10 Fundamental Components of Recovery
A Model for Recovery and High Profile Case Triage and Service Process
An Overview of Recovery
Dakota County Contracts with the four Provider Agencies
Dakota County Mental Health Recovery Model of Services
Guardianship and Self Efficacy
Guiding Principles of Recovery
Identifying Readiness for Change Tool
What Does It All Mean and Are You Ready
Motivation and Engagement Handouts
Psychiatric View of Recovery Model

Adult Foster Care Placement Packet
Foster Care Handbook
Foster Care Openings
How to Make a Placement
IRTS Placement Request Form
AdultHousingReferral.docxAdult Housing Referral

Pre-Petition Screening
60-90 Day Treatment Report to the Court
90 Day Report to the Court Stay of Commitment
Acknowledgment of Petitioner
Examiner's Statement in Support of Petition for Commitment
Final Report to Court Stay of Commitment
Final Treatment Report to the Court
Health Officer Hold Order
Intent to Revoke Provisional Discharge
Notice of Pre-Petition Screening
Pre-Petition Screening Report
Price Sheppard or Jarvis Petition
Professional Petition for Judicial Commitment
Relative Petition for Judicial Commitment
Report to Court - Notice of Intent to Revoke Provisional Discharge
Treating Physician's Recommendation to the Court
Your Right to Appeal Actions by Social Services

Last updated: 9/2/2015 3:44 AM