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Office of Mental Health

OMH Forms Listed by Form Number

OMH Forms Listing – by Topic

OMH forms available for download are listed below

There are also some forms available for a fee. These are listed in the Printing & Design Services Catalog or call the Design Center at (518) 473-3574.

Form Number Form Name File Format
J1 Offerer's Affirmation of Understanding Attachment PDF
J2 OMH Offerer Disclosure of Prior Non Responsibility Determinations Attachment PDF
J4 Notification of Restricted Period Under Procurement Lobbying Act For Sole, Single or Preferred Vendors Attachment PDF
MED 907 Level of Care (LOC) HTML & PDF
OMH 11 Authorization for Release of Information (English |  اردو |  中文 |  PyCCКИЙ |  Español |  Kreyòl Ayisyen) PDF
OMH 167 Application for Prior Approval Review 14 NYCRR 551 Personalized Recovery Oriented Services (PROS) Program (Part 512) PDF
OMH 270 Universal Referral Screening Form (URF) PDF
OMH 445 Authorization for Patient Interview HTML
OMH 446 Authorization for Patient Photograph HTML