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Suffolk New York Form 7004: What You Should Know

This program offers treatment for serious and chronic mental illness and substance use disorder for residents who qualify, and provides on-site rehabilitation during the time of inpatient treatment. The AOT program is part of the Department of Mental Health's Outpatient Mental Health Services. You must be a resident of the five boroughs of New York City to be eligible to receive AOT treatment. Who is eligible to seek treatment from the program? You must be: A resident of Manhattan, Brooklyn, Queens, Brooklyn, Bronx, Staten Island, or the New York metropolitan region or another borough of the City; Not under 12 years of age; and Not mentally ill or addicted to drugs (but do have these conditions). What is AOT? ​ 1. To see a video tour of New York City Assisted Outpatient Treatment at Cedars-Sinai Medical Center click here. 2. To access our website to apply for treatment, click here. How to Apply NYS Assisted Outpatient Treatment You must meet the eligibility criteria listed above to submit an application to NYS Assisted Outpatient Treatment. If you cannot meet the eligibility criteria, please fill out and submit the NYS Form IT-130C, Application to Apply for Treatment. The required information is described in NYS Form IT-130C. Do not return this form to the office where it was received. Please review the information that you are required to fill out. Each line must be individually completed. If you are applying to the Downtown and Harlem areas, follow the directions for that area. Please submit a copy of a health insurance card to the NYS Assisted Outpatient Treatment Unit. Please visit the website of the NYS Department of Health and Mental Hygiene to verify the name and address of an insurer. ​ When is the deadline to submit applications? The process for seeking AOT treatment from NYC Assisted Outpatient Treatment begins on 18 March 2022. If you have already submitted your applications, you should be granted AOT treatment from date that you submitted your applications. To view the date you applied with NYC Assisted Outpatient Treatment, click here. How do I know if I qualify for treatment from the AOT? NYS Form IT-130C provides information regarding eligibility for AOT treatment, the types of treatments to be provided, the program costs, and the amount of time you may expect to spend in AOT treatment.

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