Provider instructions for One Feather EAP Forms

Use forms listed on this website when providing EAP Services.
· Please feel free to photocopy and/or access the forms from this website as needed.
· Retain completed EAP clinical forms in the client’s chart.
· Fill out forms completely and/or note the reason a section could not be completed.

	EAP AFFILIATE FORMS
		Please fax or mail completed mandatory forms to One Feather EAP.
		Affiliate Manual
		Clinical Intake (mandatory submission)
		Quarterly Utilization Reporting Form (mandatory submission)
		Authorization for the Mutual Exchange of Confidential Health Information
	EAP AUXILIARY FORMS
		One Feather EAP Notice of Privacy Practices (affiliates may substitute their own privacy and HIPPA forms)
		One Feather EAP Authorization for the Mutual Exchange of Confidential Health Information (affiliates may substitute their own release forms)
		One Feather EAP Progress Notes
		One Feather EAP Treatment Plan
	HUMAN RESOURCES FORMS
		Authorization for the mutual exchange of Confidential Health Information
		EAP Referral Form
		Statement of Understanding/Authorization to Release Employment Information
		Click Here to take Survey