HEALTH RECOVERY SERVICESPROBLEM GAMBLING OUTCOMES

Fiscal Year*

Reporting Period*

Mid-Year (Jul 1-Dec 31)

Year-End (Jul 1-Jun 30)

FILE UPLOAD: Ohio Department of Mental Health And Addiction Services

Problem Gambling Treatment Allocation Mid-Year and End-of-Year Programmatic And Expenditure Report Form.

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Agency Contact

Agency Representative Providing Data*

List name of staff member providing data on this form

Email Address for Person Providing Data*

List email address of staff member providing data on this form

Phone Number for Person Providing Data*

List phone number for staff member providing data on this form

Phone

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