FORMS

Service Request Forms

The following forms are for services requiring a pre-authorization.  Please complete and submit the request before providing the service to a member.  

Other Forms

Global Distress Scale

The Optum Wellness Assessment is an integral part of the Idaho Clinical Model.  Analyses demonstrate that the Wellness Assessment scales, comprised of items from well-validated public domain scales, are both valid and reliable. Both have been independently validated to ensure psychometric integrity as an outcome tool and to affirm the tool's use as an objective assessment tool with external credibility. Please reference a more detailed discussion of the Global Distress Scale, and its reliability and validity, for additional detail.

Global Distress Scale

Provider Clinical Questions: (855) 202-0983  | PCP Psychiatric Consult press option 1