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Department of Mental Health

Department of Mental Health Record Guide For Mental Health , Intellectual and Developmental Disabilities, and Substance Use Disorders Community Providers 2016 Revision Mississippi Department of Mental Health Diana S. Mikula, Executive Director 239 North Lamar Suite 1101 Jackson, MS 39201 DMH Record Guide Contents i TABLE OF CONTENTS Section A General Information Page 1 Section B All Records Page 5 Face Sheet Consent to Receive services Rights of Individuals Receiving services Acknowledgment of Grievance Procedures Consent to Release/Obtain Information Medication/Emergency Contact Information Section C Required for All Mental Health and Substance Use Page 21

Documentation required in the Mississippi Department of Mental Health (DMH) Record Guide serves as one of the methods for planning and evaluating services and supports provided by agencies and provider s certified by the DMH. The intent of the record system outlined in this guide is to help ensure compliance with the DMH Operational Standards.

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