Provider Portal

Block Data Grant Forms
Levels 3.7 WM and 4 WM
Levels 3.5 (LT), 3.5 (ST), and 3.7
Levels 1, 2.1, and 2.5
IDU and Other Drug Protocol Form
RASE Data Form
Level 3.1
Methadone (Lvl 1), Suboxone, and Vivitrol Forms

Other Forms
Client Discharge Form
Dauphin County RFTA Packet