Complete all sections of this Authorization as appropriate to your request. Assistance provider number (do not use NPI) of the billing provider.Question: Does the Form 5 need to be notarized? Patient Name: Birth Date: (first). (m. initial). (last). Instructions for Completing IHS Form 810. Provider Forms: Psychiatric Rehabilitation Programs (PRP), Residential Rehabilitation Programs (RRP), Release of Information (ROI), Maryland RecoveryNet (MDRN) 1. Complete Sections 3 and 4 for RETURN TO CAMPUS AFTER HOSPITALIZATION. 2. Complete Sections 3, 4, and 5 for RETURN TO CAMPUS AFTER MEDICAL WITHDRAWAL.