Pm form adhs dbhs 2026

1. Click ‘Get Form’ to open the PM Form ADHS DBHS in the editor.
2. Begin by filling out the 'Member/Applicant Information' section. Enter the name, date, address, zip code, city, state, phone number, and date of birth accurately.
3. If you are filing on behalf of someone else, complete the 'Information about the person filing' section with their details including name, address, and relationship to the member/applicant.
4. In the 'Description of Appeal or Grievance' field, provide a detailed account of your appeal. Include relevant dates, names, locations, and any previous attempts to resolve the issue. You can attach additional pages if necessary.
5. Specify what solution you are seeking in the designated area.
6. For members with Serious Mental Illness, indicate whether you want services continued during the appeal process by selecting one of the options provided.
7. Finally, ensure that both you and any other signatories (like a provider or guardian) sign and date the form before submission.

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