Emergency Medication Request Form
Our emergency medication fund helps cover the cost of needed mental health medications for residents of Cleveland County. The below request should be completed by a mental health provider, community support personnel, your nurse or a doctor's office.
Limit is $50 per year for each consumer*. Once request is confirmed a check will be dropped off at the specified pharmacy or mailed depending on pharmacy location. Prescriptions must be called in or dropped off to pharmacy before a check can be delivered.
Please note: We do not provide funding for benzodiazepines.
*Special circumstances where need exceeds $50 will be considered on an individual basis.