Letter of Collaboration mar3 - Oklahoma Department of - odmhsas 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the names of the collaborating facilities in the designated fields for Facility A and Facility B.
3. Enter the Member's Name and Recipient ID # in the appropriate sections to ensure accurate identification.
4. Review the terms of collaboration outlined in the document, ensuring all parties understand their responsibilities.
5. Each facility should complete their respective service plans, detailing services provided, and ensure they are developed collaboratively.
6. Have the clinicians from both facilities sign and date their agreement at the bottom of the form.
7. The member (14 or older) must also sign and date their agreement to this treatment approach.
8. If applicable, have a parent/guardian sign, indicating their relationship to the member and date it accordingly.
9. Fill out the division of monthly dollar rates for each facility as indicated, ensuring compliance with CAR/ASI/TASI limits.

Start using our platform today to streamline your document editing and signing process for free!