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Information and Forms for Currently Contracted Providers
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Home > Employee Assistance Program > Network Providers Information > Information and Forms for Currently Contracted Providers

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Information and Forms for Currently Contracted Providers


EAP Network of Contracted Providers Guidelines

EAP Client Records Forms:
  • Billing Forms Checklist
  • Invoice
  • Assessment
  • Recommendation & Closure
  • Referral Waiver
  • Authorization for Use or Disclosure of Protected Health Information

EAP Forms for Clients:
  • Client Intake Packet
    (includes Client Intake Data, Statement of Understanding, and Notice of Privacy Practices)

 

 

 

Contact Information
Address:
Washington State EAP
PO Box 47540
Olympia WA 98504-7540

 

Fax:
360-664-0498

 

Questions? Call:
Contract Manager
877-313-4455
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