This Provisional Plan of Care and Freedom of Choice Form is used for all youths enrolling in CSoC when an authorization is being made at the time of enrollment.
- This Provisional Plan of Care Form is also available in Spanish and Vietnamese.
This Provisional Plan of Care and Freedom of Choice Form is used when adding a service, along with the Plan of Care, after enrollment.
- This Provisional Plan of Care and Freedom of Choice Form is also available in Spanish and Vietnamese.
The Certification of Need for Psychiatric Hospitalization
Psychological testing request forms must accompany the plan of care if this service is needed.
- A Psychological testing form can be obtained by clicking here.
**All authorization requests for outpatient services must be included in the member’s plan of care.**
Additionally, crisis services can be requested by telephone at 1-800-424-4489 when the crisis occurs.
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