SUD Referral Sources Information
Forms for Referral Sources
To refer clients into substance use disorder treatment services funded by the State of Idaho, please see the documents 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.
Funding Profile Form Updated February 7, 2016
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, by clicking the download button to the right or Click Here.
See Funding Profile Instructions for additional information, by clicking the download button to the right or Click Here.
Funding Profile Form Instructions Updated February 7, 2016
Instructions for filling out the Funding Profile Form.
See Funding Profile Instructions for additional information, by clicking the download button to the right or Click Here.
See Funding Profile Instructions for additional information, by clicking the download button to the right or Click Here.
Authorization for Use and Disclosure Form Updated October 25, 2015
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.
Click the download button to the right or Click Here.
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.
Click the download button to the right or Click Here.
IDHW General Release of Information Form Updated October 25, 2015
Release of information form for Idaho substance abuse treatment and recovery support services.
Click the download button to the right or Click Here.
Click the download button to the right or Click Here.
General Release of Information Form Updated October 25, 2015
General form for consent to release and exchange information.
Click the download button to the right or Click Here.
Click the download button to the right or Click Here.
Clinical Quality Coordinator (CQC) Contact Information Updated June 26, 2019
Current contact information for BPA Health Clinical Quality Coordinators
Idaho Supreme Court (ISC):Problem Solving Court Funding Information Updated June 26, 2019
Pregnant Women/Women with Dependent Children (PWWC) Funding Information Updated June 26, 2019