CCS Provider Forms

CCS Module Login Page

Forms for All CCS Staff

• Agency Fax Cover Sheet [revised 10/31/2018]
• C-SSRS
• Release of Information (ROI)
  • form-enabled Microsoft Word version
  • non-fillable PDF version
• Supervision / Clinical Collaboration Log
• CCS Service Provider Orientation & Training
  • CCS Service Provider Orientation Checklist
  • On-going Training Log
  • Rehab Worker Training Checklist

Forms for Service Facilitation Staff

• Physician Prescription for CCS [added 02/06/2018]
• Assessment and Recovery Team Template [revised 02/12/2018]
  • C-SSRS
• Assessment Summary Template [revised 4/26/2016]
• Irretrievable Documents Form
• Transfer Summary [revised 11/2023]
• Recovery Team Meeting Roster Template [revised 01/27/2019]
• CCS Discharge Summary
• Dane County Mental Health Consumer Status Data Form