Please e-mail completed QCMR Forms to: dmhs.qcmr@dhs.nj.gov
Contracted program Commitments for DMHAS contracts should be prepared, stored and submitted utilizing the various Microsoft Word Templates listed below for those programs included in your DMHAS Contract:
- Choose the appropriate Annex A forms;
- Using the tab or arrow keys to cycle through the entry boxes, enter descriptive data and contract commitment figures in the pre-set data entry boxes;
- Save the forms with your own unique filename; and,
- Submit the proposed Annex A commitments to both your Regional Program Analyst and Contract Administrator.
NOTE: Use the tab key or arrow keys to enter data and move between data boxes (do not use the "enter" key).
Should you have any questions or difficulty with this format, please call your Contract Administrator at (609) 438-4234.
Budget Code |
Program |
Download |
12 |
Involuntary Outpatient Commitment (IOC) |
Adobe Word |
13 |
Designated Screening Center Services |
Adobe Word |
14 |
Early Intervention and Support Services (EISS) |
Adobe Word |
15 |
Emergency Services |
Adobe Word |
18 |
Outpatient Services |
Adobe Word |
18 |
Bilingual, Bicultural Community and Outreach Services |
Adobe Word |
19 |
Intensive Outpatient Treatment and Support Services |
Adobe Word |
21 & 23 |
Partial Care/Partial Hospitalization |
Adobe Word |
24 |
Residential Services |
Adobe Word |
27 |
Community Support Services |
Adobe Word |
28 |
Community Advocate/POST |
Adobe Word |
28 |
Legal Services |
Adobe Word |
29 & 34 |
Career Services |
Adobe Word |
31 |
PACT - Programs in Assertive Community Treatment |
Adobe Word |
32 |
ICMS - Integrated Case Management Services |
Adobe Word |
33 |
PATH - services for the homeless
(Level of Service Summary Sheet) |
Adobe Word
Adobe Word |
35 |
Acute Care Family Support Programs |
Adobe Word |
35 |
IFSS (Intensive Family Support Services) |
Adobe Word |
36 |
Self-Help Centers |
Adobe Word |
38 |
Justice Involved Services |
Adobe Word |
ANNEX A COVERPAGE / INSTRUCTIONS
PROGRAM & UNIT OF SERVICE DEFINITIONS
INFORMATION SHEET (required for each contracted Program)
PROGRAM COMMITMENTS SUMMARY (lists key Program figures)
CLIENTS CONTRACTED LEVEL OF SERVICE PROFILE