parent and child getting a tour around facility

Mental Health Centers in Topeka

Contracting Community Mental Health Centers (CMHCs)

Contracting Community Mental Health Centers (CMHCs)

If you have a contract with FSGC to use our Crisis Resolution Program or Overnight Respite Care, we encourage you to review the information below for accessing CRP or Overnight Respite Care for your client. Links to necessary paperwork are also included.

staff reading book to kids

More information on CMHCs

To refer a client for CRP or Overnight Respite Care, the referring CMHC needs to forward the following completed documents to FSGC:

    • Admission Referral to CRP / Overnight Respite – CMHC Contracts: This document will explain how the program works and how your client can access it. The referring Qualified Mental Healthcare Professional (QMHP), the client and the client’s parent or legal guardian must sign it.
    • Screening Document: This form must be completed if the client is being diverted from the State Hospital.
    • Treatment Plan/Plan of Care: FSGC needs the client’s treatment goals and objectives along with their billing diagnosis for this service.
    • Use and Disclosure Form: This form allows CMHCs to exchange information.
    • Contact Information: Please include the CMHC Contact Person’s phone number.


Forms for referred clients from outside Shawnee County

FSGC staff members will review the referral and clinical documentation as soon as possible to determine approval for admission. Once our staff makes a determination, FSHC will contact the CMHC. If the admission is approved, the following documents can be completed by the parent or legal guardian. Parties can send these completed forms to FSGC in advance or the parent/legal guardian can bring the documents with them at admission.

  • Medication Authorization Form: Complete the top section of the form for each medication.
  • Health Checklist for Emergency/Temporary Care
  • Authorization for Emergency Medical Care: A new one needs to be filled out annually.
  • Admission/Discharge Permission and Consent Form

By mail:

Family Service & Guidance Center
800 S.W. Lane St.
Topeka KS 66604
Attention: Crisis Administrative Assistant

By fax:

Family Service & Guidance Center
Attention: Crisis Administrative Assistant
Fax: 785.783.8227

By secure e-mail:

parent discussing treatment with staff

Have any questions about forms?

If you have questions, please contact Gaylene Cook at 785.295.6981. You can also call 785.232.5005 and ask for the Crisis Department.

If you represent a Community Mental Health Center and would like to arrange a contract for Overnight Respite Care or the Crisis Resolution Program, contact Travis Freed, LMLP, Director of Crisis & Recovery Services, at 785.295.6973.