DMH Coversheet

The Department of Mental Health and the Department of Social Services have worked together to create the DMH coversheet. This coversheet identifies the applications of DMH consumers who need an MRT determination of disability. Along with the DMH coversheet, application, and any supporting verification the submitting agency/facility should also include medical records which show that the DMH consumer has a disability based on a mental illness or developmental disability.

DMH Coversheet - Download this PDF to make the fields editable. 

View this flow chart for help in determining when the DMH coversheet should be used. 

For consumers in the CPR program the most recent psychosocial evaluation signed or cosigned by a psychiatrist or a licensed clinical psychologist is often the best documentation for MRT to use to establish the disability. If the psychosocial evaluation is over 6 months old or was not signed or co-signed by a psychiatrist or licensed clinical psychologist an IM-60A (linked on the DMH coversheet) with the Diagnosis section and the Determination of incapacity section completed and signed by a psychiatrist or licensed clinical psychologist.

Learn how MRT makes their determination of disability

Once the application is received with a DMH coversheet it will be screened to make sure all information needed to make a determination has been received. If additional verification is needed this will be requested, but will extend the timeframe for processing.

The application can be processed most quickly when the original application includes all verification of income and resources, the completed MRT Packet, and medical records.