Additional dbt form 2026

1. Click ‘Get Form’ to open the additional DBT Authorization Form in the editor.
2. Begin by filling out the 'Recipient Information' section. Enter the recipient's last name, first name, middle initial, MHCP recipient ID number, and the dates of both the current diagnostic and functional assessments in MM/DD/YYYY format.
3. If applicable, provide details in the 'Exclusionary Services' section. Indicate if DBT is being provided concurrently with other services and describe the rationale for this in the designated area.
4. In the 'Treatment Duration' section, specify the expected duration of DBT treatment by entering start and end dates. Include any anticipated discharge criteria and expected changes in function due to DBT involvement.
5. Address each of the four criteria for additional authorization by providing detailed descriptions of recipient participation, progress, need for skill acquisition, and planning for discharge.
6. Complete the 'Provider Statement' section by typing or printing your name, title, signing where required, and dating the form.
7. Finally, attach any supporting documentation as specified at the end of the form before submitting your request.

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