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Behavioral Health Portal Contact Us

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Your Name*
Phone Number*
Brief description of concern*
Member/Family Member you are concerned about*
Can we share your name with the employee? *
1. Yes
2. No
Code of Concern (refer to cheat sheet)?*
1. Green
2. Yellow
3. Orange
4. Red
We intend to follow up with concerns within 48 hours. Does this concern need more immediate attention?*
1. Yes
2. No