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Pnmi application maine

Pnmi 2026

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The document is a Universal PNMI Referral/Application Form from the DHHS Office of Adult Mental Health Services. It collects comprehensive information about an individual seeking mental health services, including personal details, income sources, housing status, referral sources, special needs, legal issues, diagnosis, current symptoms, treatment history, and medical history. The form aims to facilitate the referral process for individuals with mental health needs.

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Click ‘Get Form’ to open the pnmi in the editor.
Begin by entering the date at the top of the form. Then, indicate if the consumer is an AMHI Class Member by selecting 'YES' or 'NO'.
Fill in the consumer's name, gender, current address, marital status, date of birth, and social security number in the respective fields.
Provide details about income sources and amounts. Include MaineCare number and status, as well as any housing subsidies if applicable.
Specify the referral source and contact information. Indicate which Community Support Network (CSN) the consumer prefers to live in.
Detail the primary and secondary PNMI program choices along with reasons for referral and any special considerations needed.
Complete sections regarding legal issues, diagnosis, current symptoms, treatment history, and medical updates as required.

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What is a PNMi?

Private non-medical institution (PNMI): a MaineCare provider that is required to meet special requirements to provide either Community Supports or Residential Services. This may include supported housing, residential programs, or intensive in-home services.

What is a PNMi in Maine?

▶ PNMI = Private Non-Medical Institutions.

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