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REQUEST FOR PROPOSALS RFP NUMBER: DATE ISSUED:0A1116 July 3, 2013The State of Ohio, through the Department of Administrative Services, Office of Information Technology, for the Ohio Department of

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How to fill out mha17366 form ohio department

01

Obtain a copy of the MHA17366 form from the Ohio Department of Mental Health and Addiction Services website or office.

02

Read the instructions carefully to understand what information is required to fill out the form.

03

Fill in your personal information such as name, address, phone number, and date of birth.

04

Provide details about your mental health or addiction history, including any diagnoses or treatments you have received.

05

If applicable, include information about any medications you are currently taking or have taken in the past.

06

Sign and date the form to certify that all the information provided is accurate.

07

Submit the completed form to the appropriate department or office as instructed.

Who needs mha17366 form ohio department?

01

Individuals seeking mental health or addiction services from the Ohio Department of Mental Health and Addiction Services may need to fill out the MHA17366 form.

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What is mha17366 form ohio department?

The MHA17366 form is a specific form used by the Ohio Department of Mental Health and Addiction Services for reporting mental health and addiction services data.

Who is required to file mha17366 form ohio department?

Agencies and organizations that provide mental health and addiction services in Ohio are required to file the MHA17366 form.

How to fill out mha17366 form ohio department?

To fill out the MHA17366 form, organizations must gather required data regarding services provided, client demographics, and outcomes, and accurately complete each section of the form following the provided guidelines.

What is the purpose of mha17366 form ohio department?

The purpose of the MHA17366 form is to collect important data on mental health and addiction services to inform state policy, funding, and service provision.

What information must be reported on mha17366 form ohio department?

The MHA17366 form requires reporting of data such as client demographics, types of services provided, service outcomes, and any relevant performance metrics.

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