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Publications & Documents

Block Grant

Title Type Posted Date
FFY2020 Combined SA/MH Application with Notice for Comment PDF 07/30/2019
2019 SABG Annual Report PDF 06/12/2019
FFY 2019 SAMH Mini Block Grant Application with Notice PDF 07/31/2018
FFY 18-19 Combined Substance Abuse and Mental Health Block Grant Application PDF 08/01/2017

Brochures

Title Type Posted Date
Senior Medicaid Patrol Brochure PDF 05/08/2019
Diabetes Brochure PDF
MDS Section Q Brochure PDF
Diabetes Brochure - Spanish PDF

Directories

Title Type Posted Date
DASEP Map PDF 08/08/2019
DASEP DWI Services Directory PDF 08/08/2019
Community Mental Health Center Directory PDF 07/03/2019
Community Mental Health Center Directory by County PDF 07/03/2019
SFY19 Arkansas Prevention Services Providers List PDF 02/22/2019
Licensed Substance Abuse Treatment Providers PDF 08/02/2018
Psychology Internship Supervisors PDF 07/13/2017

Forms

Title Type Posted Date
24 Hour Contact Information Form PDF 05/12/2019
DHS-4000 Authorized to Disclose Health Info-Release of Info Form PDF 05/11/2019
DHS-4000 Release of Info Authorization - Spanish Edition PDF 05/11/2019
DHS-8504 Start Service Form PDF 05/10/2019
DHS-8505 Informed Consent PDF 05/09/2019
DHS-8506 MFP Assessment and Personal History Form PDF 05/08/2019
DHS-8507 Checklist of Clients Rights Form PDF 05/07/2019
DHS-8508 Statement of Rights & Responsibilities of MFP Participants Form PDF 05/06/2019
DHS-8510 Demonstration Services Freedom of Choice Form PDF 05/05/2019
DHS-8511 Transition Risk Plan Form PDF 05/04/2019
DHS-8512 Risk Mitigation Monthly Form PDF 05/03/2019
DHS-8520 General Professional Recommendations Form PDF 05/02/2019
DHS-8521 Demonstration Services Plan of Care Form PDF 05/01/2019
DHS-8523 Housing Information Form PDF 04/30/2019
MediMaide Checklist (Need copy of Prescriptions) Form PDF 04/29/2019
Consent to Discuss Form PDF 04/28/2019
Tier Level Request Form PDF 04/27/2019
Transition Goods and Services Form PDF 04/26/2019
AAS-9511 Change of Client Status Form PDF 04/02/2019
APS-0001 Request for Adult Maltreatment Registry Information DOC 09/12/2016
Helping Hands Respite Programs form PDF
AAS-9511 Change of Client Status Form PDF

General Information

Title Type Posted Date
Mental Health Commitment - Involuntary Committment PDF 09/20/2018
Mental Health Committment - Immediate Confinement DOC 09/20/2018
Arkansas Strategic Prevention Plan PDF 08/20/2018
Forensic Seminar Schedule DOC 05/11/2016
Arkansas Money Follows the Person Demonstration Operational Protocol PDF 01/30/2014
DASEP Guidelines PDF 10/30/2012

Manuals

Title Type Posted Date
Regional Alcohol and Drug Detoxification (RADD) Manual PDF 07/29/2019
Licensure Standards for Alcohol and other Drug Abuse Treatment Programs PDF 04/26/2019
Alcohol and Drug Prevention Rules of Practice and Procedure Manual PDF 04/26/2019
Infant Mental Health Therapist Standards Manual with application PDF 07/17/2018
Peer Support, Family Support Partner, and Youth Support Specialist Standards Manual and application PDF 01/01/2018
ADMIS Manual Revised Oct 2017 PDF 10/13/2017

Physician Certification Forms

Title Type Posted Date
PHYSICIAN CERTIFICATION OF SERIOUS EMOTIONAL DISTURBANCE PDF 02/08/2018
PHYSICIAN CERTIFCATION OF ADULT WITH A SERIOUS MENTAL ILLNESS DOC 02/08/2018

Procedures

Title Type Posted Date
Provider Reconsideration Submission Instructions PDF 03/28/2019
Provider Reconsideration Registration Instructions PDF 03/28/2019
Physician Certification of Adults with a Serious Mental Illness Policy and Procedure Instructions PDF 10/12/2011

Publications

Title Type Posted Date
ICD-10 Training Fall 2015 PDF 09/24/2015
ICD-10 Training 6/17/2015 PDF 07/08/2015

Reports

Title Type Posted Date
Mental Health Commitment - Involuntary Committment PDF 09/20/2018
Infant Mental Health Therapist Provider Training slide deck PDF 02/15/2018
Special Services Program Report SFY 2015 PDF 02/03/2016
Resource Summary Report SFY 2016 PDF 02/02/2016
Adult Protective Services (APS) Taskforce Report PDF

Resources

Title Type Posted Date
Senior Medicaid Patrol Brochure PDF 05/08/2019
Infant Mental Health Training Information PDF 02/20/2019
PSS FSP and YSS posting PDF 09/07/2018
PSS, FSP & YSS Provider Training slides 02/15/2018
Peer Support, Family Support Partner, and Youth Support Specialist Training Information PDF 02/14/2018
Implementing Trauma-Informed Approaches in Access to Recovery Programs PDF 08/01/2012
Dealing with the Effects of Trauma PDF

Rules

Title Type Posted Date
HIPAA Notice of Privacy Practices PDF 10/13/2010

Staff

Title Type Posted Date
Psychology Staff List PDF

State Plan

Title Type Posted Date
Aging State Plan - Fiscal 2016 - 2019 PDF 05/08/2016

Synar Report

Title Type Posted Date
2019 Arkansas Annual Synar Report PDF 06/27/2019
2018 Arkansas Annual Synar Report PDF 11/08/2017
2017 Arkansas Annual Synar Report PDF 11/06/2016
2015 Arkansas Annual Synar Report PDF 12/09/2015
2016 Arkansas Annual Synar Report PDF 12/08/2015
2014 Arkansas Annual Synar Report PDF 10/16/2014
2013 Arkansas Annual Synar Report PDF 01/24/2013
2012 Arkansas Annual Synar Report PDF 11/29/2011
2011 Arkansas Annual Synar Report PDF 12/31/2010
2010 Arkansas Annual Synar Report PDF 12/31/2009
2009 Arkansas Annual Synar Report PDF 12/31/2008
2008 Arkansas Annual Synar Report PDF 01/01/2008
2007 Arkansas Annual Synar Report PDF 01/02/2006
2006 Arkansas Annual Synar Report PDF 01/01/2006

Arkansas Department
of Human Services
(501) 682-1001

TTY: 1-800-285-1131 or dial 711 for Arkansas Relay Service

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