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Information for Referral Sources

Forms for Referral Sources

Documents to for approved referral sources to refer clients into substance use disorder treatment services funded by the State of Idaho are listed below. To help clients choose a provider, search for Treatment & Recovery Support Services providers here. To help clients funded by the Idaho Department of Juvenile Corrections choose a provider, use the IDJC provider search here.

The forms on this page are for the following client populations: ATR-4, IDHW-Child Protection/SUD (CP/SUD), IDHW-Adult Mental Health Court, IDHW-Domestic Violence Court (DV Court), IDHW-Misdemeanant Problem Solving Court (Misdemeanant PSC), IDHW-Supervised Misdemeanant.

Questions? Contact BPA Health at 800-922-3406.

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Funding Profile Form Updated February 7, 2016
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Approved referral sources submit this form to BPA Health to request funding. This form/process is for the following client populations: ATR-4, IDHW-Child Protection/SUD (CP/SUD), IDHW-Adult Mental Health Court, IDHW-Domestic Violence Court (DV Court), IDHW-Misdemeanant Problem Solving Court (Misdemeanant PSC), IDHW-Supervised Misdemeanant. Services for all other IDHW clients should be initiated by a phone call to BPA Health,services for IDOC clients should be initiated by a referral from IDOC to a provider.

See Funding Profile Instructions for additional information.
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Funding Profile Form Instructions Updated February 7, 2016
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Instructions for filling out the Funding Profile Form.
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Authorization for Use and Disclosure Form Updated October 25, 2015
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Authorization for use and disclosure to release information to approved agency/entity. Referral sources should include this form with the Funding Profile Form.

This form/process is for the following client populations: ATR-4, IDHW-Child Protection/SUD (CP/SUD), IDHW-Adult Mental Health Court, IDHW-Domestic Violence Court (DV Court), IDHW-Misdemeanant Problem Solving Court(Misdemeanant PSC), IDHW-Supervised Misdemeanant. Services for all other IDHW clients should be initiated by a phone call to BPA Health, services for IDOC clients should be initiated by a referral from IDOC to a provider.
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IDHW General Release of Information Form Updated October 25, 2015
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Release of information form for Idaho substance abuse treatment and recovery support services.
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General Release of Information Form Updated October 25, 2015
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General form for consent to release and exchange information.