PROVIDER RESOURCES
We strive to work together to build stronger and healthier communities through an integrated system of care, and that starts with ensuring our providers have all the resources they need. We are proud to offer the following resources and tools to our service provider network and partners. Service providers can find all the necessary documents and forms to fulfill their contractual obligations and ensure they are able to effectively serve people in need.
65E-4 Clinical Records
Adult CM
Adult Family Care Homes Records
Assessment
Attachment I Compliance
Behavioral Health Consultant (BMC)
Block Grant for Women
BNet Clinical 1
BNet
CAT Team
CFS FSPT
Children Residential
Child Welfare MDT
Community Action Team (CAT) Staffing
Cost Reimbursement
CQI IRAS
CQI Suicide Prevention Best Practices
Crisis Respite Service
Crisis Stabilization Unit Services
Cultural Linguistic Competency
DHoH Services – Client
DHoH Services – Organization
DHoH Services – Personnel
Employee Eligibility – Organization
Employee Eligibility – Personnel Tool
FACT Model Fidelity
FACT Clinical Records
Family Services Treatment Team (FSTT)
Financial 65E-14 Audit
Financial Contract Audit
Financial Data Validation
988-211
Financial Desk Audits
Financial Fiscal Mgmt Audit
Financial CMHBG Audit
Financial-SAPTBG-Audit-Revised080320
Family Intervention Specialists (FIS)
FIT Services Monitoring Tool
Fixed Rate Monitoring Tool
HIPAA Notice of Privacy Practices
HIPAA Privacy Data Security – Organization
HIPAA Privacy-Data Security – Personnel
HIV Early Intervention
IDP
IDP- Org
Incidental Expenditures – Client Files
Incidental Expenditures – Organizational
IRAS Reports
Level 2 Background Screening rev. 09.12.24
Level 2 Background Screening PO Agreements
LMH-ALF
LSF PATH FY20-21 Grant Compliance
MAT Clinical Tool
MH Clubhouse
MH Outpatient and Case Management
Mobile Response Team – MOU Check
Mobile Response Team Tool
National Voter Registration Act
NSP Care Coordination Monitoring Tool
Opioid State Targeted Response-STR revised
Prevention Activity Logs
Prevention Program – Level 1 (Uni & Sel)
Prevention Program (Level 2)
Prevention Evaluation
Prevention Needs Assessment
Prevention Program Description
Recovery Support Services (RSS) Tool
RTF Tool
SA Case Management Tool
SA Detoxification
SA Intervention Clinical Tool
SA Outpatient Clinical Tool PDF
SA Residential
SANDR Reporting
Self-Directed Care Program Monitoring Tool
SOR MAT Interview
SOR Non-Methadone MAT Monitoring
Standard Contract
Standard Financial Audit
Statewide Wraparound Monitoring Tool
Subcontract Monitoring
Substance Abuse and Block Grant HIV
Substance Record
Suicide Prevention
Sulzbacher Mental Health Offender Program Tool
TANF – Clinical
TANF SAMH Checklist
Transitional Voucher
Measuring Recovery Principles and Practices Guidance Tool_June2020
Recovery-Oriented QI Complete Scoring Tools_June2020
CAT Clinical Performance Measure Analysis Monitoring Tool
CRS Clinical Performance Measure Analysis Monitoring Tool
Family First Prevention Services Act (FFPSA) Teams Monitoring Tool
FACT Clinical Performance Measure Analysis
FIT Clinical Performance Measure Analysis Monitoring Tool
MRT Clinical Performance Measure Analysis Monitoring Tool
PATH COMPLIANCE NEW SEPT 2021
PATH RECORDS NEW SEPT 2021
RCO Monitoring Tool
SOAR COMPLIANCE NEW Sept 2024
SOAR RECORDS NEW 2024
Supportive Employment Records NEW Oct 2024
Supportive Housing Records NEW Sept 2021
Civil State Hospital Audit
First Episode Psychosis
FirstEpPsych Perf Measures Audit
FMT Performance Measures
FMT
Forensic Service Interview
Forensic State Hospital
Mental Health Offender Program Tool
(Required)
LSF Standard Contract: LSF Standard Contract – FY 23-24
Attachment I: Network Service Provider Attachment I – FY 24-25
Attachment II (Lobbying): Network Service Provider Attachment II CF 1123_Lobbying – FY 24-25
Attachment III (Audit): Network Service Provider Attachment III CF 1120_Audit – FY 24-25
Attachment IV (HIPAA): Network Service Provider Attachment IV – HIPAA – FY 24-25
Exhibit A – Required Reports – FY 24-25
Exhibit B – Performance Outcome Measures – FY 24-25
Exhibit C and D – Projected Operating and Capital Budget – FY 24-25
Exhibit C-1 – Actual Expenses and Revenues Schedule – CF-MH 1037 FY 23-24
Exhibit C-1 – Actual Expenses and Revenues Schedule – FY 23-24
Exhibit E – Agency Capacity Report – FY 24-25
Exhibit F – Program Descriptions – FY 24-25
Exhibit G – Submission of Information – Fillable – FY 24-25
Exhibit H – Funding Detail – FY 24-25
Exhibit I – Invoice FY 24-25
Exhibit J – Local Match Calculation Form FY 24-25
Exhibit K – Federal Block Grant Requirements – FY 24-25
Exhibit L – Covered Service Rates by Program – FY 24-25
Exhibit M – Bed Hold Request Form – Fillable – FY 24-25
Exhibit M2 – Forensic Bed Hold Form – FY 24-25
Exhibit N – Incidental Expenses Request Approval Form – Fillable – FY 24-25
Exhibit O – Expenditure Reconciliation Report – FY 24-25
Exhibit O – Expenditure Reconciliation Report – No Admin – FY 24-25
Exhibit P – Cost Reimbursement Template – Part 1 – FY 24-25
Exhibit P – Cost Reimbursement Template – Part 2 – FY 24-25
Exhibit Q – Network Development Template – FY 24-25
Exhibit R- Respite Extension Request Form – FY24-25
Incorporated Document 1 – LSF Glossary of Contract Terms – FY 23-24
Incorporated Document 2 – Evidence Based Practice Guidelines – FY 23-24
Incorporated Document 3 – State and Federal Laws, Rules, Regulations – FY 23-24
Incorporated Document 4 – Auxilliary Aids for Deaf and Hard of Hearing – FY 23-24 rev. 06.01.24
Incorporated Document 5 – SAMH Funding Resource Guide – FY 23-24
Incorporated Document 6 – SIPP – FY 23-24
Incorporated Document 7 – Outpatient Forensic MH Services – FY 23-24 rev. 01.01.24
Incorporated Document 8 – SMHTF Admission and Discharge Processes – FY 23-24
Incorporated Document 9 – LMH-ALF Monitoring – FY 23-24
Incorporated Document 10 – SOAR – FY 23-24 rev. 05.01.24
Incorporated Document 11 – Expiration Termination Transition Planning – FY 23-24
Incorporated Document 12 – Crisis Counseling Program – FY 23-24
Incorporated Document 13 – Tangible Property Reqs – FY 23-24
Incorporated Document 14 – Performance Outcomes Manual – FY 23-24
Incorporated Document 15 – Prevention Services and PPG – FY 23-24
Incorporated Document 16 – Integration with Child Welfare – FY 23-24 rev. 05.01.24
Incorporated Document 16 – Integration with CW – CW Integration Manual – FY 23-24 rev. 05.01.24
Incorporated Document 17 – SDC – FY 23-24
Incorporated Document 18 – BNET – FY 23-24
Incorporated Document 19 – Financial Management Requirements – FY 23-24
Incorporated Document 20 – FACT – FY 23-24
Incorporated Document 20 – FACT Monthly Referral Report – FY 23-24
Incorporated Document 20 – Outcome Measure Data Collection Tool
Incorporated Document 20 – Transitional Voucher – FACT Monthly Report
Incorporated Document 20 – FACT Monthly Vacancy Report FY 24-25
Incorporated Document 20 – FACT Monthly Referral Report – FY 24-25
Incorporated Document 21 – TANF – FY 23-24
Incorporated Document 21 – TANF – One-time Payment Form Exhibit A FY
Incorporated Document 22 – Crisis Respite Services – FY 24-25
Incorporated Document 22- Crisis Respite Services – Adult Respite Report – FY 24-25
Incorporated Document 23 – Womens Special Funding SA Services for PWM – FY 23-24 rev. 10.01.23
Incorporated Document 24 – PATH – FY 24-25
Incorporated Document 24 – PATH – PATH Incidental Expenses Summary Report
Incorporated Document 24 – PATH – PATH Quarterly Housed Report
Incorporated Document 25 – IDP FY 23-24
Incorporated Document 25 – IDP – IDP Report
Incorporated Document 26 – HIV Early Intervention Services – FY 24-25
Incorporated Document 27 – National Voter Registration Act – FY 23-24
Incorporated Document 28 – FIT – FY 23-24 rev. 01.24.24
Incorporated Document 28 – FIT Client Information Form – FY 23-24
Incorporated Document 29 – Seclusion and Restraint Reporting – FY 23-24
Incorporated Document 30 – Family Service Planning Team f/k/a Children’s Mental Health Care Coordination Program – FY 24-25
Incorporated Document 30 – FSPT Monthly POS Template-Appendix K
Incorporated Document 30 – FSPT – Appendix L – FY 23-24
Incorporated Document 31 – Care Coordination – FY 23-24
Incorporated Document 31 – Care Coordination Spreadsheet – FY 24-25
Incorporated Document 31 – CCSU Care Coordination Report
Incorporated Document 31 – SEN Prevention Program Report
Incorporated Document 32 – Suicide Prevention Best Practices – formerly STR – FY 23-24
Incorporated Document 33 – Central Receiving System – CRS Performance Measures Report – FY 24-25
Incorporated Document 33 – Central Receiving System – FY 23-24
Incorporated Document 34 – Transitional Voucher – FY 24-25
Incorporated Document 34 – Transitional Voucher – Appendix 1 -Transitional Voucher Incidental Expenses FY 23-24
Incorporated Document 34 – Transitional Voucher – EXH A – Trans Vouch Pur Req (Fillable) – FY 24-25
Incorporated Document 34 – Transitional Voucher – EXH B – Grad Asses Scale (Fillable) – FY 23-24
Incorporated Document 34 – Housing Checklist – FY24-25
Incorporated Document 35 – State Opioid Response (SOR) rev. 06.01.24
Incorporated Document 35 – SOR – RCO Monthly Report
Incorporated Document 35 – SOR – Paramedicine Report
Incorporated Document 35 – SOR – Hospital – Jail Bridge Report rev. 010124
Florida SOR 2 Guidance 12.21.21
Florida SOR Q & A 1.7.21
Florida SOR 3 Resource Guide
Incorporated Document 36 – Recovery Management Practices – FY 24-25
Incorporated Document 37 – Supported Employment – FY 23-24
Incorporated Document 37 – Supported Employment – Supp Emp Tracking Sheet
Incorporated Document 38 – Juvenile Incompetent to Proceed (JITP) – FY 23-24
Incorporated Document 38 – Juvenile Incompetent to Proceed (JITP) – JITP Tracker
Incorporated Document 39 – Co-Responder Program (CoR) – FY 23-24
Incorporated Document 39 – Co-Responder Program (CoR) Report
Incorporated Document 40 – Community Action Treatment (CAT) Team for Ages 0-10, (CAT Tier 3 Variation) FY 23-24
Incorporated Document 41 – School Telehealth Proviso FY 23-24
Incorporated Document 42 – Community Action Treatment (CAT) Team – FY 23-24 rev. 120123
Incorporated Document 42 – Community Action Treatment (CAT) Team – Appendix 1-3 – FY 23-24
Incorporated Document 42 – Community Action Treatment (CAT) Team – Exhibit A – FY 23-24
Incorporated Document 42 – Community Action Treatment Monthly Census Report FY 23-24
Incorporated Document 43 – Mobile Response Team (MRT) – FY 23-24
Incorporated Document 43 – Mobile Response Team (MRT) Report
Incorporated Document 44 – Forensic Multi-Disciplinary Team (FMT) FY 24-25
Incorporated Document 44 – Forensic Multi-Disciplinary Team (FMT) – Template 25 FMT – LSFHS Version
Incorporated Document 44 – Forensic Multi-Disciplinary Team (FMT) Monthly Vacancy Report
Incorporated Document 45 – Supported Housing FY 23-24
Incorporated Document 46 – Coordinated Specialty Care for ESMI – First Episode Psychosis FY 23-24
Incorporated Document 46 – Coordinated Specialty Care for ESMI-FEP-Monthly-Report
Incorporated Document 47 – Clubhouse FY 23-24
Incorporated Document 48 – Multidisciplinary Child Welfare Teams, Family Intensive Treatment (FIT) Tier 2 Variation FY 23-24
Incorporated Document 49 – Linking, Advocating, Treating, Transitioning, Empowering & Recovery Support (LATTERS) Teams, Florida Assertive Community Treatment (FACT), Tier 2 Variation FY 23-24
Incorporated Document 49 – Linking, Advocating, Treating, Transitioning, Empowering & Recovery Support (LATTERS) Teams, Florida Assertive Community Treatment (FACT), Tier 2 Variation Monthly LATTERS Outcome Measures Report FY 24-25
Incorporated Document 49 – Linking, Advocating, Treating, Transitioning, Empowering & Recovery Support (LATTERS) Teams, Florida Assertive Community Treatment (FACT), Tier 2 Variation Quarterly LATTERS Report FY 24-25
Incorporated Document 50 – Family First Prevention Services Act (FFPSA0 Teams, (CAT Tier 2 Variation) FY 23-24 rev. 06.01.24
Incorporated Document 51 – 988 Implementation FY 24-25
Incorporated Document 52 – Coordinated Opioid Recovery (CORE) Network of Addiction Care
Incorporated Document 53 – Family Support Teams (FST) FY 23-24
Incorporated Document 54 – Opioid Settlement FY23-24
Incorporated Document 55 – Children Respite FY24-25
CFOP for the Opioid Settlement Trust Fund – DRAFT
*Network Service Provider Attachments for specific/special programs are incorporated in the appropriate contracts and not included here. Requests to view the Attachments can be made to LSF Health Systems.
Reporting Templates:
SMHTF Transitional Program Report FY 24-25
Transitional Program Report FY 24-25 – Meridian Williams Manor
MANAGING ENTITY (ME) AND THE FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES (DCF) CONTRACT:
The components of the contract between the ME, Lutheran Services Florida, and DCF can be found here for the appropriate fiscal year:
https://www.myflfamilies.com/services/substance-abuse-and-mental-health/samh-providers/managing-entities
The requirements of the Data System are located here:
https://www.myflfamilies.com/services/samh/providers/FASAMS
Request Access to KIS Express, OneDrive or WITS – SOR Program’s Web Infrastructure for Treatment Services:
Technical Assistance (TA) is provided to Network Service Providers as needed. The documents presented in the TA sessions can be found here.
CF-MH 1037: FY 2022-23-Reconciliation Workshop: MH1037 Instructions for 22-23 Revised
CF-MH 1037: FY 2022-23-Reconciliation Workshop (RCOs): MH1037 Instructions for 22-23 RCOs
Exhibit C and D – Proj Operating and Capital Budget: FY 2024-2025 Exhibit C and D Workshop: Exhibit C and D Instructions for 24-25
Exhibit E – Agency Capacity Report: FY 2024-2025 Exhibit E Workshop: Exhibit E Instructions for 24-25
