Documents

Departmental FormsDepartmental Forms
Standard Practice ManualStandard Practice Manual
Information NoticesInformation Notices
Interim Instruction NoticesInterim Instruction Notices
ResourcesResources
For ProvidersFor Providers

Name	Modified Date	Program and Number
Notice to Patient Client – English	06/14/2023	MDS030
Notice to Patient Client – Spanish	06/14/2023	MDS030_S
Notice to Patient Client – Mandarin	06/14/2023	MDS030_M
Notice to Patient Client – Vietnamese	06/14/2023	MDS030_V
Notice to Patient Client D.O. – English	06/14/2023	MDS031
Confidentiality Privacy and Security Compliance Training FAQs	04/16/2025
Notice to Patient Client D.O. – Spanish	06/14/2023	MDS031_S
Notice to Patient Client D.O. – Mandarin	06/14/2023	MDS031_M
Notice to Patient Client D.O. – Vietnemese	06/14/2023	MDS031_V
Statement of Awareness	03/31/2023	HR003
Naloxone Distribution Project Acknowledgement Form	03/02/2023	MDS026
Naloxone Distribution Project Acknowledgement Form (Spanish)	03/02/2023	MDS026_S
Enhanced CareManager (ECM) Progress Note	04/25/2025	CLP062
Naloxone Distribution Project Acknowledgement Form (Vietnamese)	03/02/2023	MDS026_V
Naloxone Distribution Project Acknowledgement Form (Mandarin)	03/02/2023	MDS026_M
Substance Use Screening Log	01/24/2023	SUDRS055
Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (Mandarin)		COM004_M
Tuberculosis Screening Questionnaire	05/02/2024	SUDRS059
Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (Spanish)		COM004_S
Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (VIE)		COM004_V
Change of Provider Request Form – 18pt. font (Spanish)	06/28/2022	QM047_S
Request for Translation and Interpretation Services	06/12/2024	CUL012
Translation Service Request Form	05/16/2025	CUL002
Interpretation Service Request Form	05/16/2025	CUL006
Opioid Agreement for Buprenorphine Medication Assisted Treatment (Spanish)	08/02/2022	SUDRS040_S
Opioid Agreement for Buprenorphine Medication Assisted Treatment (English)	08/02/2022	SUDRS040_E
FFS Provider Conflict of Interest/Disclosures	01/13/2025	COM047
Attestation for Reproductive Health Care	12/19/2024	COM046
Electronic Signature Request Checklist	08/03/2022	COM043
Out of Network Services Request	07/12/2022	QM039
Beneficiary Nondiscrimination Notice (Mandarin)	01/01/2025	QM026_M
Beneficiary Nondiscrimination Notice (Vietnamese)	01/01/2025	QM026_V
Your Rights Attachment (NOABD) (Mandarin)	11/15/2023	QM024_M
Your Rights Attachment (NOABD) (Vietnamese)	11/15/2023	QM024_V
Change of Provider Request Form – 18pt. font (English)	06/28/2022	QM047_E
Code of Professional Conduct for Drug and Alcohol Staff	05/05/2022	SUDRS001
Adolescent (Age 12-17) and Young Adult ASAM TRIAGE LEVEL OF CARE SCREENING – Instructions	05/10/2022	SUDRS044
Consent for SUD Care Coordination Services (Spanish)		SUDRS035_S
Care Coordination Needs Determination Screening Tool (English)		SUDRS036_E
SUD Care Coordination Needs Determination Screening Tool (Spanish)		SUDRS036_S
SUD Care Coordination Plan (English)	06/01/2023	SUDRS037_E
SUD Care Coordination Plan (Vietnamese)	06/01/2023	SUDRS037_V
SUD Care Coordination Plan (Mandarin)	06/01/2023	SUDRS037_M
SUD Care Coordination Plan (Spanish)	06/01/2023	SUDRS037_S
Care Coordination Discharge Summary (English)		SUDRS038_E
Care Coordination Discharge Summary (Spanish)		SUDRS038_S
CalOMS Administrative Discharge		SUDRS045
CalOMS Admission	12/16/2024	SUDRS046
CalOMS Admission Instructions		SUDRS047
CalOMS Standard Discharge		SUDRS048
Telehealth Consent Form (Fillable)	11/27/2024	MDS042
Telehealth Consent Form (Printable)	11/27/2024	MDS042 (Printable)
CalOMS Standard Discharge Instructions		SUDRS049
Privacy and Security Incident Reporting Form	05/03/2022	COM042
Medi Cal Fee For Service Provider Manual		MHPFFS51319
DBH Discipline – Taxonomy Codes	04/21/2025
Staff Master Worksheet Update
Staff Master Worksheet
Adult Screening Tool for Medi-Cal Mental Health Services	09/26/2024	DHCS 8765 A
Youth Screening Tool for Medi-Cal Mental Health Services	09/26/2024	DHCS 8765 C
Transition of Care Tool for Medi-Cal Mental Health Services	09/26/2024	DHCS 8765 B
Mental Health Professional Licensing Waiver Request	08/30/2022	DHCS 1739
Title 22 Fair Hearing Rights	01/31/2023	SUDRS002_E
Title 22 Fair Hearing Rights (Spanish)	01/31/2023	SUDRS002_S
Title 22 Fair Hearing Rights (Mandarin)	01/31/2023	SUDRS002_M
Title 22 Fair Hearing Rights (Vietnamese)	01/31/2023	SUDRS002_V
Client Admission Agreement_V	01/13/2025	SUDRS022_V
Notice of Personal Rights / Civil Rights	11/27/2023	SUDRS003_E
Notice of Personal Rights / Civil Rights (Spanish)	11/27/2023	SUDRS003_S
Notice of Personal Rights / Civil Rights (Mandarin)	11/27/2023	SUDRS003_M
Client Admission Agreement	01/13/2025	SUDRS022_E
Notice of Personal Rights / Civil Rights (Vietnamese)	11/27/2023	SUDRS003_V
Client Admission Agreement_M	01/04/2025	SUDRS022_M
Client Admission Agreement_S	01/01/2025	SUDRS022_S
Substance Use Disorder and Recovery Services Intake	06/01/2023	SUDRS025
Adult (Age 21 and Over) DMC-ODS Transition		SUDRS026
Immediate Need Profile	05/06/2022	SUDRS027
Adult (21+) ASAM Level of Care Screening	05/07/2025	SUDRS028
Handbook Summary and Acknowledgement Form (English)	05/10/2021	SUDRS029_E
Handbook Summary and Acknowledgement Form (Spanish)	05/10/2021	SUDRS029_S
SUDRS-MH Grievance and Appeals Process Brochure (English)	05/10/2021	SUDRS030_E
SUDRS-MH Grievance and Appeals Process Brochure (Spanish)	05/10/2021	SUDRS030_S
SUDRS-MH Grievance and Appeals Process Brochure- 18pt. font (Spanish)	05/10/2021	SUDRS030_S
SUDRS-MH Grievance and Appeals Process Brochure-18pt. font (English)		SUDRS030_E
Adolescent (Age 12-17) and Young Adult ASAM Level of Care Screening	09/04/2024	SUDRS031
Adolescent (age 12-17) And Young Adult (age 18-20) Dmc-ods Transition New!	05/10/2021	SUDRS033
SUD Referral	11/15/2023	SUDRS034
Recovery Services Plan	05/10/2021	SUDRS039
CalOMS Admission-Outpatient	12/16/2024	SUDRS051
ASAM Level of Care	03/07/2024	SUDRS042
Therapeutic Foster Care (TFC) Prior Authorization Request	04/16/2025	CHD022
Screening Tool For Therapeutic Foster Care (TFC) Services	04/16/2025	CHD024
DBH-SUDRS CalOMS Annual Update	08/02/2024	SUDRS052
Therapeutic Behavioral Services Service Assessment	05/11/2021	CHD012
Therapeutic Behavioral Services Risk Assessment	05/11/2021	CHD013
Therapeutic Behavioral Services Referral Form	05/11/2021	CHD014
Children’s Interagency Authorization To Exchange Confidential Health Information (phi)	05/11/2021	CHD025_E
Children’s Interagency Authorization To Exchange Confidential Health Information (phi) (spanish)	05/11/2021	CHD025_S
Episode Opening And Closing Codes	05/11/2021	CLP_CODES
Possession of a Weapon Notice for Clinics	09/16/2024	SFT009
Possession of a Weapon Notice for Clinics_Vietnamese	09/16/2024	SFT009_Vietnamese
Possession of a Weapon Notice for Clinics_Mandarin	09/16/2024	SFT009_Mandarin
Possession of a Weapon Posted Notice for Clinics_Spanish	09/16/2024	SFT009_Spanish
Community Crisis Response Teams (CCRT) Consent Letter to Parents and Adults (Mandarin)	01/21/2025	CLP060_M
Community Crisis Response Teams (CCRT) Consent Letter to Parents and Adults (Vietnamese)	01/21/2025	CLP060_V
Community Crisis Response Teams (CCRT) Consent Letter to Parents and Adults	01/21/2025	CLP060_E
Community Crisis Response Team (CCRT) Consent Letter to Parents and Adults (Spanish)	01/21/2025	CLP060_S
Client Payment Agreement	05/11/2021	CLP001
Client Episode Summary (csi)	05/11/2021	CLP002
Initial Contact Form (English)	08/26/2021	CLP003_E
Initial Contact Form (spanish)	05/11/2021	CLP003_S
Csi Periodic Data	05/11/2021	CLP004
Adult Clinical Assessment (a-1)	05/11/2021	CLP005
Charge Data Correction Invoices	11/20/2024	CLP010
Universal Charge Data Invoice (Printable)	10/29/2024	CLP006 (Printable)
Universal Charge Data Invoice (Fillable)	10/24/2024	CLP006 (Fillable)
Client Resource Evaluation	10/24/2024	CLP012
Adult Psychiatric Evaluation (Fillable)	09/05/2024	CLP013 (Fill)
Adult Psychiatric Evaluation (Printable)	09/05/2024	CLP013 (Print)
Child Adolescent Psychiatric Evaluation and Update	11/13/2024	CLP014
Child/adolescent Clinical Assessment	05/11/2021	CLP015
Child/adolescent Clinical Assessment-cans-sb	05/11/2021	CLP015-1
Physical Assessment	05/11/2021	CLP016_E
Physical Assessment (spanish)	05/11/2021	CLP016_S
Client Recovery Evaluation (annual)	05/11/2021	CLP017
Request To Waive Consumer’s Responsibility To Pay For Medications	05/11/2021	CLP018
Care Necessity	05/11/2021	CLP019
Psychological Testing Referral Form	04/13/2022	CLP020
Healthy Homes Screening/assessment	05/11/2021	CLP021
Diagnosis	05/11/2021	CLP022
Client Recovery Plan/issp	05/11/2021	CLP024_E
Client Recovery Plan/issp (spanish)	05/11/2021	CLP024_S
Discharge Summary	05/11/2021	CLP025
Abnormal Involuntary Movement Scale	05/11/2021	CLP026
Interdisciplinary Note	10/16/2024	CLP027
Services Teams Actions	09/24/2024	CLP028
Caregiver’s Authorization Affidavit	05/11/2021	CLP029_E
Caregiver’s Authorization Affidavit (spanish)	05/11/2021	CLP029_S
Request For Verification Of Veterans Status For Mental Health And/or Substance Abuse Services	05/11/2021	CLP030
Consent And Authorization To Exchange Confidential Information For Veterans Status	05/11/2021	CLP031
Medication Support Services Plan	05/11/2021	CLP035_E
Medication Support Services Plan (spanish)	05/11/2021	CLP035_S
Release And Hold Harmless Agreement	05/11/2021	CLP042_E
Release And Hold Harmless Agreement (spanish)	05/11/2021	CLP042_S
Host Care Plan	05/11/2021	CLP043
Interdisciplinary Care Team (ict) Referral Form	05/11/2021	CLP044
DBH 5150/5585 Assessment/Evaluation/Cris Form (DHCS 1801)	12/23/2024	CLP050
Columbia-suicide Severity Rating Scale	05/11/2021	CLP051
Chart Audit Tool	05/11/2021	QM001
Annual Psychiatric Assessment Review Form	05/11/2021	QM005
Referral Summary for Referral to Managed Care Plan (MCP)	05/11/2021	QM018
Guidelines For Completing Referral Summary For Referral To Managed Care Plan (mcp) Attachment	05/11/2021	QM018_1
Tier Transition Letter Attachment Ii	05/11/2021	QM020_E
Tier Transition Letter Attachment Ii (spanish)	05/11/2021	QM020_S
Your Rights Attachment (NOABD) (English)	11/15/2023	QM024_E
Your Rights Attachment (NOABD) (Spanish)	11/15/2023	QM024_S
Your Rights Attachment (nar)	05/11/2021	QM025_E
Your Rights Attachment (nar) (spanish)	05/11/2021	QM025_S
Beneficiary Nondiscrimination Notice (English)	01/01/2025	QM026_E
Beneficiary Nondiscrimination Notice (Spanish)	01/01/2025	QM026_S
Language Assistance Taglines	01/01/2025	QM027_E
Delivery System Notice (NOABD) (Vietnamese)”	11/15/2023	QM029_V
Delivery System Notice (NOABD)	11/15/2023	QM029_E
Delivery System Notice (NOABD) (Spanish)	11/15/2023	QM029_S
Delivery System Notice (NOABD) (Mandarin)	11/15/2023	QM029_M
Modification Notice (NOABD)	11/15/2023	QM030_E
Modification Notice (NOABD) (Mandarin)	11/15/2023	QM030_M
Modification Notice (NOABD) (Vietnamese)	11/15/2023	QM030_V
QM030_S “Modification Notice (NOABD) (Spanish)	11/15/2023	QM030_S
Change Order Request Routing Slip	02/12/2025	QM044
State Pre-audit Chart Review Audit Tool	05/11/2021	QM046
Change of Provider Request Form	06/28/2022	QM047_E
Change of Provider Request Form (Spanish)	06/28/2022	QM047_S
Request for Second Opinion QM048_E Revised!	08/24/2021	QM048_E
Request for Second Opinion (Spanish) QM048_S Revised!	08/24/2021	QM048_S
Mental Health And Alcohol And Drug Services Agency Evaluation	05/11/2021	QM049
Grievance Form	05/11/2021	QM050_E
Grievance Form (spanish)	05/11/2021	QM050_S
Action Appeal Form	05/11/2021	QM051_Et
Quality Assurance Audit At Annual Point	05/11/2021	QM056
Medication Monitoring Questionnaire	05/11/2021	QM057
Denial Notice (NOABD) (Vietnamese)	11/15/2023	QM058_V
Denial Notice (NOABD) (Mandarin)	11/15/2023	QM058_M
Denial Notice (NOABD)	11/15/2023	QM058_E
Denial Notice (NOABD) (Spanish)	11/15/2023	QM058_S
Termination Notice (NOABD) (Vietnamese)	03/28/2025	QM059_V
Termination Notice (NOABD) (English)	11/15/2023	QM059_E
Termination Notice (noabd) (spanish)	05/11/2021	QM059_S
Timely Access Notice (NOABD)	11/15/2023	QM061_E
Timely Access Notice (NOABD) (Spanish)	11/15/2023	QM061_S
Timely Access Notice (NOABD) (Mandarin)	11/15/2023	QM061_M
Timely Access Notice (NOABD) (Vietnamese)	11/15/2023	QM061_V
Medi-Cal Site Certification Checklist	07/19/2022	QM074
Mental Health Plan (mhp) To Medi-cal Plan (mcp) Referral Form For Non Open Cases	05/11/2021	QM075
Financial Liability Notice (NOABD)	11/15/2023	QM078_E
Financial Liability Notice (NOABD) (Spanish)	07/28/2022	QM078_S
Financial Liability Notice (NOABD) (Mandarin)	07/27/2022	QM078_M
Financial Liability Notice (NOABD) (Vietnamese)	07/27/2022	QM078_V
Scheduling Template	05/11/2021	CLK003
Schedule Change Request	05/11/2021	CLK004
Physician Request Form	05/11/2021	CLK006
Myavatar Program Assignment (mental Health)	05/11/2021	CLK028
Myavatar Program Assignment (mental Health)(spanish)	05/11/2021	CLK028_S
Myavatar Initial Contact Form (mental Health	05/11/2021	CLK030
Myavatar Initial Contact Form (mental Health) (spanish)	05/11/2021	CLK030_S
Authorization to Release Protected Health Information (PHI) Mandarin	06/02/2025	COM001_M
Authorization to Release Protected Health Information (PHI) (Spanish)	06/02/2025	COM001_S
Authorization to Release Protected Health Information (PHI) (Vietnamese)	06/02/2025	COM001_V
Code of Conduct	11/15/2023	COM003
Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices	10/19/2022	COM004_E
Certification Review Hearing – Waiver Of Presence	05/11/2021	COM006
Sensitive Chart	05/11/2021	COM007
Outpatient Treatment Reauthorization Request For Adults	05/11/2021	COM010
List Of Disclosures Of Protected Health Information (phi)	05/11/2021	COM012
Consent For Outpatient Treatment	05/11/2021	COM013_Et
Consent For Outpatient Treatment (spanish)	05/11/2021	COM013_S
Consent For Outpatient Treatment (vietnamese)	05/11/2021	COM013_V
Medical Care Authorization For Minor	05/11/2021	COM014_E
Medical Care Authorization For Minor (spanish)	05/11/2021	COM014_S
Consent For Sound And/or Photographic Recordings	05/11/2021	COM015_E
Consent For Sound And/or Photographic Recordings (spanish)	05/11/2021	COM015_S
Consent To Record And/or Photograph And Authorization For Use Or Disclosure	05/11/2021	COM016_E
Consent To Record And/or Photograph And Authorization For Use Or Disclosure (spanish)	05/11/2021	COM016_S
Advance Health Care Directive	05/11/2021	COM018_E
Advance Health Care Directive (spanish)	05/11/2021	COM018_S
Delegation Of Tx Consent	05/11/2021	COM019
Conflict of Interest Disclosure Statement	01/29/2025	COM020
Access To Medical Records Request	05/11/2021	COM021_E
Access To Medical Records Request (spanish)	05/11/2021	COM021_S
Request To Amend Protected Health Information (phi)	05/11/2021	COM023_E
Request Request To Amend Protected Health Information (phi) (spanish)	05/11/2021	COM023_S
Response To Request To Amend Protected Health Information (phi)	05/11/2021	COM024_E
Response To Request To Amend Protected Health Information (phi) (spanish)	05/11/2021	COM024_S
Release Of Information: Patient’s Right Of Access To His/her Own Medical Record	05/11/2021	COM026_E
Release Of Information: Patient’s Right Of Access To His/her Own Medical Record (spanish)	05/11/2021	COM026_S
Oath of Confidentiality	01/14/2022	COM027
Advance Health Care Directive (brochure)	05/11/2021	COM028_E
Advance Health Care Directive (brochure) (spanish)	05/11/2021	COM028_S
Advance Health Care Directive (brochure) (vietnamese)	05/11/2021	COM028_V
Privacy And Security Agreement Confidentiality Statement	05/11/2021	COM033
Tracking Of Phi Records Delivered Log	05/11/2021	COM034
General Chart Room Log	05/11/2021	COM035
Ineligible Persons Policy Acknowledgement And Attestation	05/11/2021	COM036
Attestation Regarding Completion Of Sanction Checks	05/11/2021	COM037
Aca 1557 Grievance Form – Spanish	11/14/2024	COM038_S
ACA 1557 Grievance Form	11/14/2024	COM038
Aca 1557 Grievance Form (spanish)	05/11/2021	COM038_S
Electronic Signature Agreement and E-Signature and Provider Signature List	02/17/2023	COM039
AB2275 Flow Chart	01/29/2025	PR005
Notice of Patients' Entitlement to a Certification Review Hearing	01/29/2025	PR003
	12/02/2024	j1802
	12/02/2024	j1802
Guidance for Detaining Persons by 5150 Application in Non LPS Designated Facility	01/29/2025	PR006
myAvatar Policy & Procedure Acknowledgment Form	03/26/2025	COM041
Patients’ Rights Grievance Form	05/11/2021	PR001_E
Patients’ Rights Grievance Form (spanish)	05/11/2021	PR001_S
Patients’ Rights Office Grievance Appeal Form	05/11/2021	PR002_E
Patients’ Rights Office Grievance Appeal Form (spanish)	05/11/2021	PR002_S
Service Authorization Request 03/01/2009	08/12/2021	MH5125
Client Assessment 03/01/2009	08/12/2021	MH5120
Client Assessment Update 03/01/2009	08/12/2021	MH5121
Client Plan 03/01/2009	08/12/2021	MH5122
Action Appeal Form (Spanish)	09/01/2021	QM051_S
Request for Restriction of Confidential Communication	09/22/2022	COM030_E
Request for Restriction of Confidential Communication (Spanish)	09/26/2022	COM030_S
Response to Request for Restriction of Confidential Information	09/16/2021	COM031_E
Response to Request for Restriction of Confidential Information (Spanish)	09/16/2021	COM031_S
Medical/Behavioral Health Clearance	05/01/2024	SUDRS024
Payment Denial Notice (NOABD)	11/15/2023	QM060_E
Payment Denial Notice (Spanish)	11/22/2021	QM060_S
Authorization Delay Notice (NOABD)	11/15/2023	QM033_E
Authorization Delay Notice (Spanish)	11/15/2023	QM033_S
Grievance and Appeal Timely Resolution Notice (NOABD)	11/15/2023	QM062_E
Grievance and Appeal Timely Resolution Notice (Spanish)	11/22/2021	QM062_S
Unusual Occurrence/Incident Report	04/07/2022	QM053
CLP009 Charge Data Invoice (Fillable)	10/24/2024	CLP009 (Fillable)
Charge Data Invoice (Printable)	10/24/2024	CLP009 (Printable)
Termination of Provider Notice Template – Mandarin	05/22/2024	CLP045
Termination of Provider Notice Template – Vietnamese	05/22/2024	CLP045
Termination of Provider Notice Template	05/11/2022	CLP045
Mode of Service	04/28/2022	BOP024
Adult (21+) ASAM Triage Level of Care Screening	05/05/2022	SUDRS043
Consent for SUD Care Coordination Services (English)		SUDRS035_E
Termination of Provider Notice Template_Spanish	05/25/2022	CLP045_S
Notice of Grievance Resolution	06/23/2022	QM028_E
Notice of Grievance Resolution (Spanish)	06/23/2022	QM028_S
Receipt of Grievance Acknowledgement Letter	06/23/2022	QM036_E
Receipt of Grievance Acknowledgement Letter (Spanish)	06/23/2022	QM036_S
Grievance Investigation Response Form	06/23/2022	QM076_E
Grievance Investigation Supplemental Response Form	06/23/2022	QM077_E
Fagerstrom Test for Nicotine Dependence	06/22/2022	SUDRS053
Pre-Licensed/Out-of-State Licensed Psychologists Statement of Awareness for Continued Employment	08/30/2022	HR006
Non-Medication Resource Log and Instructions	07/19/2023	MDS032
Contingency Management: Recovery Incentives Program Consent Form	08/06/2024	SUDRS054
Contingency Management: Recovery Incentives Program Consent Form (Spanish)	01/05/2024	SUDRS054
Authorization Delay Notice (Mandarin)	11/15/2023	QM033_M
Authorization Delay Notice (Vietnamese)		QM033_V
SUDRS058 Discharge Summary	01/05/2024	SUDRS058
SUDRS Discharge Plan_E	01/05/2024	SUDRS057
SUDRS057_V SUDRS Discharge Plan (Vietnamese)	01/05/2024	SUDRS057_V
SUDRS057_S SUDRS Discharge Plan (Spanish)	01/05/2024	SUDRS057_S
SUDRS057_M SUDRS Discharge Plan (Mandarin)	01/05/2024	SUDRS057_M
Contingency Management: Recovery Incentives Program Consent Form (Vietnamese)	01/05/2024	SUDRS054
Contingency Management: Recovery Incentives Program Consent Form (Mandarin)	01/05/2024	SUDRS054
Electroconvulsive Therapy (ECT) Referral Form	01/17/2024	MDS040
Controlled Substance Count Sheet	05/16/2024	MDS041
Trainee Statement of Awareness	04/17/2024	HR025
Threat Incident Against County of San Bernadino Employees	09/04/2024
Termination Notice (NOABD) (Mandarin)	04/03/2025	QM059_M
Authorization to Release Protected Health Information (PHI) English		COM001_E
Notice to Clients – Licensed Providers	06/25/2025	CLP067
Notice to Clients – Unlicensed Providers	06/25/2025	CLP068
Client Health Questionnaire and Initial Screening Questions	06/11/2025	SUDRS060
Notice to Clients – Unlicensed Providers (Mandarin)	06/25/2025	CLP068_M
Notice to Clients – Unlicensed Providers (Spanish)	06/25/2025	CLP068_S
Notice to Clients – Unlicensed Providers (Vietnamese)	06/25/2025	CLP068_V
Notice to Clients – Licensed Providers (Spanish)	06/25/2025	CLP067_S
Notice to Clients – Licensed Providers (Vietnamese)	06/25/2025	CLP067_V
Notice to Clients – Licensed Providers (Mandarin)	06/25/2025	CLP067_M

Name	Modified Date	Program and Number
Antidepressant Prescribing Guidelines	06/28/2023	MDS2035
Client API Access Control, and Availability Procedure	05/09/2025	IT5026-1
Client API Access, Control, and Availability Policy	05/09/2025	IT5026
Provider Directory API Policy	05/08/2025	IT5027
Sedative Hypnotics Practice Guidelines	06/28/2023	MDS2037
DBH Record Retention Policy	05/09/2025	COM0962
Peer and Family Advocate Certification Procedure	03/12/2025	CLP0845-1
Peer and Family Advocate – Certified and Uncertified Policy	03/12/2025	CLP0845
Title 22 Fair Hearing Rights Policy	02/03/2025	SUDRS0205
Medication Assisted Treatment (MAT) Procedure	03/05/2025	SUDRS0252-1
Medication Assisted Treatment (MAT) Policy	03/05/2025	SUDRS0252
Mood Stabilizers Prescribing Guidelines	06/28/2023	MDS2038
Antipsychotic Practice Guidelines	06/28/2023	MDS2039
Medication Disposal Procedure	05/30/2023	MDS2023
Clinical Laboratory Onsite Testing Procedure	05/01/2024	MDS2033-2
Guidance for 5150 Detainment – No-LPS Facilities	01/27/2025
Clinical Laboratory Registration Procedure	05/01/2023	MDS2033-1
Prior Authorization for Therapeutic Foster Care (TFC) Policy	04/16/2025	CHD0320
Prior Authorization for Therapeutic Foster Care (TFC) Procedure	04/16/2025	CHD0320-1
Workstation and System Security Policy	08/13/2024	IT5022
Clinical Laboratory Registration Policy	04/27/2023	MDS2033
Utilization Management, Audit, Oversight, Recoupment Standards for Specialty Mental Health Services	03/02/2023	QM6058
Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services	03/02/2023	QM6059
Single Case Agreement Policy	04/17/2024	SUDRS0245
Single Case Agreement Procedure	04/17/2024	SUDRS0245-1
Utilization Management, Audit, Oversight and Recoupment Standards for Substance Use Disorder Service	03/02/2023	SUDRS0244
Hybrid Telework Policy	11/30/2022	HR4032
Hybrid Telework Procedure	11/30/2022	HR4032-1
Emotional Support Animal Clinical Documentation Policy	10/12/2022	CLP0843
Continuity of Care Procedure	07/18/2022	QM6044-2
Network Adequacy Policy	05/17/2021	QM6043
DMC-ODS Requirements for period 2022-2026	08/08/2022	SUDRS0241
Documentation Requirements for all SMHS DMC and DMC-ODS Services	07/28/2022	QM6056
Transition of Care Procedure	07/18/2022	QM6044-3
Clinical Supervision for Pre-Licensed Psychologists	02/16/2022	CLP0842
Technology Account Management Policy	01/23/2025	IT5017
Data Sanitization Policy	09/25/2024	IT5016
DBH-IT Data Encryption	02/28/2022	IT5018
DATAR Policy (SUDRS0236)	08/29/2023	SUDRS0236
DATAR Procedure (SUDRS0236-1)	08/28/2023	SUDRS0236-1
Expenditure of the SUBG Funds Policy	11/21/2024	SUDRS0221
Transition to Higher Level of Care Procedure	09/18/2024	SUDRS0226-1
Transition to Higher Level of Care Policy	09/18/2024	SUDRS0226
Request to Change the DBH Websites Policy (BOP3047)	12/20/2022	BOP3047
Request to Change the DBH Websites Procedure (BOP3047-1)	12/20/2022	BOP3047-1
Physician Consultation Services	09/13/2021	SUDRS0224
Outpatient Chart Manual
Adult System Of Care, Intensive And Aggressive Case Management, And Acsp Coordinated Services	05/13/2021	ADT0101
Case Management Services	05/13/2021	ADT0102
Reporting Dependent Adult/Elder Abuse and Neglect Policy		ADT0103
Reporting Dependent Adult/Elder Abuse and Neglect Procedure		ADT0103-01
Adult System Of Care Out-of-county Placement Policy	05/13/2021	ADT0105
Forensic Contraband Policy And Procedure	05/13/2021	ADT0106
Dbh Alcohol And Other Drug (aod) Programs Counselor Certification Policy	05/13/2021	ADS0201

SUDRS Code of Professional Conduct Policy	11/19/2024	SUDRS0202
Charitable Choice Procedure	10/06/2021	SUDRS0209-1

Medication Policy for Clients Seeking SUD Services	08/27/2024	SUDRS0210
Youth Substance Use Disorder Crisis Intervention Policy	07/24/2023	SUDRS0212
Perinatal Treatment	01/19/2023	SUDRS0213
Admission Preference and Interim Services Policy	09/13/2021	SUDRS0214
Admission Preference and Interim Services Procedure		SUDRS0214-1
Accessibility of Services Policy	08/15/2022	SUDRS0220
Substance Use Disorder Medication Safety And Effectiveness Policy	05/13/2021	SUDRS0223
Substance Use Disorder Service Utilization Policy	05/13/2021	SUDRS0225
Substance Use Disorder And Recovery Services Coordination Of Care Policy	05/13/2021	SUDRS0228
Substance Use Disorder And Recovery Services Coordination Of Care Procedure	05/13/2021	SUDRS0228-1
California Outcomes Measurements System (CalOMS) Monthly Reporting Policy	08/02/2024	SUDRS0229
California Outcomes Measurement System	04/13/2022	SUDRS0229-1
Post Client Satisfaction Survey Procedure	05/13/2021	SUDRS0230
Substance Use Disorder And Recovery Services Residential Prior Authorization Policy	05/13/2021	SUDRS0231
Case Management Services For Child And Adolescent Clients	05/13/2021	CHD0302
Child Abuse Reporting Policy	05/13/2021	CHD0303
Child Abuse Reporting Procedure	05/13/2021	CHD0303-1
Ab 2726 Program Policy	05/13/2021	CHD0307
Financial Interviewer Procedure	05/13/2021	CHD0308
Healthy Families Sed Services Policy	05/13/2021	CHD0309
Healthy Families Sed Services Procedure	05/13/2021	CHD0309-1
Providing Services To Foster Care, Adoption Assistance Program (aap) And Kinship Guardianship Assistance Payment (kingap) Children Placed Out-of County Policy	05/13/2021	CHD0311
Services for Children Placed Out-of-County, Foster, and Probationary Youth Procedure	02/16/2023	CHD0311-1
Providing Services To Adoption Assistance Program (aap) And Kinship Guardianship Assistance Payment (kingap) Children Placed Out-of County Procedure	05/13/2021	CHD0311-2
Children’s Fund Immediate Need Voucher Policy	05/13/2021	CHD0315
Consent for the Treatment of Minors Policy	01/22/2025	CHD0316
Consent for the Treatment of Minors for Parents Legal Guardians	01/22/2025	CHD0316-1
Children’s Fund Immediate Need Voucher Procedure	05/13/2021	CHD0315-1
Consent to Treat a Dependent Minor Procedure	01/22/2025	CHD0316-2
Service Corrections Replacements and Deletions Procedure	11/20/2024	CLK0708-1
Service Corrections, Replacements and Deletions Policy	11/20/2024	CLK0708
Outpatient Chart Manual (ocm)	05/13/2021	OCM
Lost And Found Procedure	05/13/2021	CLK0701
Assignment Of Meeting Rooms	05/13/2021	CLK0702
Clinic Responsibility For Processing Client Registration, Pfi, Cdi	05/13/2021	CLK0703
Scheduling Application Policy	05/13/2021	CLK0705
Initial Contact Form	05/13/2021	CLK0711
Procedure For Unscheduled Appointments	05/13/2021	CLK0712
Appointment Scheduling	05/13/2021	CLK0713
No Show Policy	05/13/2021	CLK0714
Field Trips/conferences	05/13/2021	CLP0802
Treatment Of Dbh Employees By Dbh Facilities	05/13/2021	CLP0804
Acknowledgement Of Abuse Reporting Duties Policy	05/13/2021	CLP0805
Clinical Supervision for Licensure AMFT, ACSW, APCC	02/16/2022	CLP0806
Supervision Of Occupational Therapists	05/13/2021	CLP0807
Consumer Benefit Assistance Protocol	05/13/2021	CLP0808
Admission Standards For Penal Code Misdemeanor Violations	05/13/2021	CLP0809
Diagnosis Of Mental Disorder	05/13/2021	CLP0810
Out-of-county Access For Mental Health Services	05/13/2021	CLP0812
Self Help Group Protocol	05/13/2021	CLP0814
Adjustment Of Client Fees	05/13/2021	CLP0815
Waiver Of Consumer’s Responsibility To Pay For Medications	05/13/2021	CLP0816
Authorization and Designation Pursuant to the Lanterman-Petris-Short (LPS) Act	09/06/2022	CLP0818
Duty to Warn and Protect Third Parties in Response To A Client Threat (Tarasoff) Policy	05/13/2021	CLP0819
Duty to Warn and Protect Third Parties in Response to a Client Threat (Tarasoff) Procedure	05/13/2021	CLP0819-1
Day Treatment Weekly Charting In Staff Meetings	05/13/2021	CLP0821
Psychological Testing	05/13/2021	CLP0822
Hiv And Aids Charting	05/13/2021	CLP0824
Disability Application	05/13/2021	CLP0826
Veterans Services Policy	09/26/2022	CLP0828
Veterans Services Procedure	09/26/2022	CLP0828-1
5150/5585 Transportation Policy	05/13/2021	CLP0829
5150/5585 Transportation Procedure	05/13/2021	CLP0829-1
Clients With Physical Medical Conditions Policy	05/13/2021	CLP0830
Cwic Referral Procedure	05/13/2021	CLP0831
Bus Pass Program Policy	05/13/2021	CLP0832
Shelter Bed Services Policy	05/13/2021	CLP0833
Client Substance Use Policy	05/13/2021	CLP0834
Client Substance Use Screening Procedure	05/13/2021	CLP0834-1
Transformational Collaborative Outcomes Management (tcom) Policy	05/13/2021	CLP0836
Transformational Collaborative Outcomes Management (tcom) Procedure	05/13/2021	CLP0836-1
Client Notice Regarding Termination of Provider Procedure	04/12/2022	CLP0837
Sending Confidential Information By Facsimile	05/13/2021	COM0901
Subpoena of Medical Records Policy	12/23/2024	COM0902
Advance Health Care Directive policy	11/13/2024	COM0903
Medical Record Security Policy for Outpatient Services	08/30/2022	COM0904
Confidentiality Of Protected Health Information (PHI)	05/14/2025	COM0905
Retention of Medical Records Policy	04/03/2023	COM0906
Unauthorized Access Of Confidential Medical Records	05/13/2021	COM0907
Medical Records Requiring Special Handling	05/13/2021	COM0908
Medical Records Requiring Special Handling Procedure	05/13/2021	COM0908-1
HIPAA Notice of Privacy Practices (NOPP) Policy	10/17/2022	COM0910
Conflict of Interest Policy	01/29/2025	COM0911
Authorization to Release PHI Policy	12/23/2024	COM0912
Authorization to Release Protected Health Information (PHI) Procedure	06/15/2023	COM0912-1
Trafficking Victims Protection Act Of 2000	05/13/2021	COM0913
Code of Conduct	07/11/2024	COM0914
Certification Of Billed Services	05/13/2021	COM0915
Compliance Verification, Monitoring And Auditing Policy	05/13/2021	COM0917
Compliance Hotline Policy	05/13/2021	COM0919
Compliance Hotline Procedure	05/13/2021	COM0919-1
Dbh Compliance Committee	05/13/2021	COM0920
Sound And Photographic Recordings Policy	05/13/2021	COM0922
Security Of Protected Electronic Health Information Policy	05/13/2021	COM0923
Data Integrity Policy	05/13/2021	COM0925
Privacy and Security Incident Sanctions	06/17/2025	COM0926
Fraud, Waste And Abuse Prevention Policy	05/13/2021	COM0927
Access and Amendment of Medical Records Policy	05/22/2025	COM0931
Ineligible Persons Procedure	08/11/2022	COM0933-1
Ineligible Persons Policy	08/11/2022	COM0933
Compliance Plan Policy	05/13/2021	COM0934
Patients’ Rights Policy	05/13/2021	COM0935
Patients’ Rights Inpatient Grievance Process	05/13/2021	COM0935-1
Patients’ Rights Outpatient Grievance Process	05/13/2021	COM0935-2
Hipaa National Provider Identifier (npi) Policy	05/13/2021	COM0938
Hipaa National Provider Identifier (npi) Procedure	05/13/2021	COM0938-1
Root Cause Analysis Policy	05/13/2021	COM0939
Right To Request Alternative Means Of Communication Protected Health Information Policy	05/13/2021	COM0941
Medicare Provider Certification Policy	05/13/2021	COM0942
Medi-Cal Eligibility Data System (MEDSLITE) Policy	02/08/2024	COM0943
Medi-cal Eligibility Data System (MEDSLITE) Procedure	02/08/2024	COM0943-1
Privacy Incident Policy	02/26/2024	COM0944
Client Grievance Policy	05/13/2021	COM0946
Mhsa Issue Resolution Process	05/13/2021	COM0947
Transportation Of Protected Health Information (phi) Policy	05/13/2021	COM0948
Transportation Of Protected Health Information (phi) Procedure	05/13/2021	COM0948-1
Affordable Care Act (ACA) 1557 Grievance Policy	06/06/2025	COM0953
Affordable Care Act (ACA) 1557 Grievance Procedure	06/06/2025	COM0953-1
Overpayment Policy	05/13/2021	COM0954
Behavioral Health Services For Clients/family	05/17/2021	CUL1002
Behavioral Health Services For Clients/family	05/17/2021	CUL1002-1
Satisfying Clients’ Language Needs	05/17/2021	CUL1004
Consumer Focus Group Policy	05/17/2021	CUL1005
Consumer Focus Group Procedure	05/17/2021	CUL1005-1
Cultural Competency Policy	05/17/2021	CUL1006
Field Testing Of Written Materials Policy	05/17/2021	CUL1010
Field Testing Of Written Materials Procedure	05/17/2021	CUL1010-1
Providing Translation Services Procedure	05/17/2021	CUL1011
Providing Interpretation Services Procedure	06/13/2022	CUL1012
Providing Written Communications in Threshold/Primary Languages for Consumers/Family Members Policy	10/24/2024	CUL1013
Cultural Competency Training Policy	05/17/2021	CUL1014
Medical Services Staff Organization	05/17/2021	MDS2002
Incorporated Employees – Fiscal Control Procedures	05/17/2021	MDS2003
Guidelines For Psychiatrists Assigned To Outpatient Clinics	05/17/2021	MDS2004
Leave Of Absence – Physicians	05/17/2021	MDS2005
Deviation From Standard Of Practice Of Medicine	05/17/2021	MDS2006
Benzodiazepine Medication Policy	05/17/2021	MDS2007
Control, Access and Accountability of Medications and Medical Supplies Policy	12/15/2022	MDS2008
Control, Access and Accountability of Medications and Medical Supplies Procedure	12/15/2022	MDS2008-1
Controlled Substance Utilization Review And Evaluation System (cures) Policy	05/17/2021	MDS2010
Controlled Substance Utilization Review And Evaluation System (cures) Procedure	05/17/2021	MDS2010-1
Injectable Medicaiton Policy	03/19/2025	MDS2012
Medication Appointment – Scheduling	05/17/2021	MDS2011
Handling Of Contaminated Waste/needles And Syringes	05/17/2021	MDS2014
Prescription Policy	05/17/2021	MDS2015
Disability Application	05/17/2021	MDS2016
Consent For Administration Of Psychotropic Medication To Minors Policy	05/17/2021	MDS2017
Physician’s Orders (treatment Plan)	05/17/2021	MDS2018
Laboratory Services/physical Assessment Policy	05/17/2021	MDS2019
Laboratory Services/physical Assessment Procedure	05/17/2021	MDS2019-1
Medication Support Groups	05/17/2021	MDS2020
Medical Services Credentialing Procedure	05/17/2021	MDS2021
Patient Assistance Program Policy	05/17/2021	MDS2022
Patient Assistance Program Procedure	05/17/2021	MDS2022-1
Clinical Practice Guideline: Clozapine	05/17/2021	MDS2025
Telehealth Policy	12/09/2024	MDS2027
Telehealth Procedure	12/09/2024	MDS2027-1
Intranasal Naloxone Policy	05/17/2021	MDS2028
Intranasal Naloxone Procedure	05/17/2021	MDS2028-1
Medication Authorization For Dependent Children And Youth Policy	05/17/2021	MDS2029
Urgent and Emergency Conditions Procedure	07/18/2022	MDS2031
Nursing Staff Orientation Protocol	05/17/2021	NUR2101
Control And Organization Of The Standard Practice Manual (spm) Policy	05/17/2021	BOP3001
Requests to Modify Standard Practice Manual Procedure	10/20/2021	BOP3002
Organization Of The Department	05/17/2021	BOP3003
Department Vision, Mission And Values Policy	05/17/2021	BOP3004
Communications Procedures	05/17/2021	BOP3005
Incoming Mail – Departmental	05/17/2021	BOP3006
Public Information And Media Release Policy	05/17/2021	BOP3007
Paid Advertising Procedure – General	05/17/2021	BOP3009
Legal Opinion From County Counsel	05/17/2021	BOP3010
Legislative Activities	05/17/2021	BOP3011
Reimbursement For Travel And Related Expenses	05/17/2021	BOP3012
Travel Procedure	05/17/2021	BOP3013
Benefits Team Policy	05/17/2021	BOP3014
Benefits Team Procedure	05/17/2021	BOP3014-1
Vehicle Use Policy	05/17/2021	BOP3015
Vehicle Use Procedure	05/17/2021	BOP3015-1
Maintenance – Plant & Equipment	05/17/2021	BOP3016
Purchasing Procedure	05/17/2021	BOP3017
Use Of Supplies And Equipment/notification Of Loss Or Damage	05/17/2021	BOP3018
Furniture And Equipment Relocation Procedure	05/17/2021	BOP3019
Surplus Inventory	05/17/2021	BOP3020
Cellular Phones	05/17/2021	BOP3022
Budget Development And Changes	05/17/2021	BOP3023
Petty Cash	05/17/2021	BOP3024
Facility Physical Security And Access Control Policy	05/17/2021	BOP3025
Facility Physical Security And Access Control Procedures	05/17/2021	BOP3025-1
Billing And Collection For Treatment Services Policy	05/17/2021	BOP3027
Gifts And Donations Policy	05/17/2021	BOP3029
Gifts And Donations Procedure	05/17/2021	BOP3029-1
Prepaid Cards Policy	05/17/2021	BOP3030
Prepaid Cards Procedure	05/17/2021	BOP3030-1
Guidelines For Promotional, Educational, And/or Informational Materials	05/17/2021	BOP3031
Dbh Review Panel For Promotional, Educations, And/or Informational Materials	05/17/2021	BOP3032
Review Of Promotional, Educational And/or Informational Materials Procedure	05/17/2021	BOP3032-1
Assignment, Closure, Merger Or Relocation Of Clinics Policy	05/17/2021	BOP3033
Closure Of Dbh Contract Provider Procedure	05/17/2021	BOP3033-1
Assignment Of Dbh Contract Provider Procedure	05/17/2021	BOP3033-2
Merger Of Dbh Contract Provider Procedure	05/17/2021	BOP3033-3
Relocation Of Clinic Procedure	05/17/2021	BOP3033-4
	12/02/2024	j1802
Telecommunication Devices Policy	05/17/2021	BOP3040
Telecommunication Devices Procedures	05/17/2021	BOP3040-1
Medi-cal Claim Certification Of Authenticity Policy	05/17/2021	BOP3042
Web Blast Policy	12/20/2022	BOP3045
Web Blast Procedure	12/20/2022	BOP3045-1
Outreach Events Policy	05/17/2021	BOP3046
Outreach Events Procedure	05/17/2021	BOP3046-1
Approval For Filling Vacancies	05/17/2021	HR4002
Advertising Procedures – Employment	05/17/2021	HR4003
New Hire Policy	05/17/2021	HR4004
Employee Separation Procedure	05/17/2021	HR4006
Work Schedules Policy	05/17/2021	HR4007
Intra-department Reassignment Policy (supersedes-employee Reassignment Requests)	05/17/2021	HR4008
Intra-department Reassignment Procedure	05/17/2021	HR4008-1
Employment Physicals	05/17/2021	HR4009
Clinical Therapists Reassignment Request	05/17/2021	HR4010
Waiver for Pre-Licensed/Out-of-State Licensed Ready Psychologists	08/30/2022	HR4011
Registration and Licensure Requirements for Pre-Licensed Providers (ASW, AMFT, APCC) Policy	07/16/2024	HR4012
Volunteer Policy	05/17/2021	HR4013
Volunteer Request And Registration Procedure	05/17/2021	HR4013-1
Non-discrimination / Equal Employment Opportunity	05/17/2021	HR4015
Dress and Grooming Policy	05/14/2024	HR4016
Personnel Records	05/17/2021	HR4018
Telephone Calls – Personal	05/17/2021	HR4019
Smoking And Tobacco Use Policy	05/17/2021	HR4020
Time And Attendance Form – How To Complete	05/17/2021	HR4021
Time And Attendance Correction	05/17/2021	HR4021-1
Vacation Leave – Request	05/17/2021	HR4023
Request for Information Technology Support Policy	03/06/2025	IT5002
Overtime Policy	05/17/2021	HR4025
Position Transfer Reassignment & Borrowing Policy	05/17/2021	HR4026
Position Transfer Reassignment & Borrowing Procedure	05/17/2021	HR4026-1
Tuberculosis Screening Policy	05/17/2021	HR4030
Tuberculosis Screening Procedure	05/17/2021	HR4030-1
Procedure For Purchasing Computer Equipment	05/17/2021	IT5001
Internet Account Policy	04/08/2025	IT5003
IT5004 Computer and Network Appropriate Use Policy	08/29/2023	IT5004
Electronic Mail Policy	04/08/2025	IT5005
Risk Assessment Policy	05/17/2021	IT5007
Device and Media Controls Policy	01/27/2025	IT5008
User- I.d	05/17/2021	IT5009
Superseded by myAvatar User Account Creation and Reinstatement Procedure	12/15/2021	IT5012-5
Medi-Cal Site Certification Policy	07/22/2022	QM6002
Medi-Cal Site Certification Procedure	07/22/2022	QM6002-1
Qshort-doyle And Short-doyle/medi-cal Clinic Change Of Ownership Or Location	05/17/2021	QM6003
Research And Evaluation Functions	05/17/2021	QM6004
Research Review Committee	05/17/2021	QM6005
Requesting an Initial Choice of Provider or Change of Provider Procedure	07/19/2022	QM6006-1
Requesting an Initial Choice of Provider or Change of Provider Policy	07/19/2022	QM6006
Credentialing Policy	05/17/2021	QM6008
Credentialing Procedure	05/17/2021	QM6008-1
Quality Management Committee Membership/participation	05/17/2021	QM6009
Written Informing Materials Policy	05/17/2021	QM6012
Post State Audit Procedures	05/17/2021	QM6014
Pre State Chart Audit Responsibilities & Procedures	05/17/2021	QM6015
Billing Guidelines For Quality Assurance Activities	05/17/2021	QM6019
Outpatient Chart Audit – Site Review Policy	05/17/2021	QM6020
Investigating And Reporting Death Of A Dbh Client	05/17/2021	QM6021
Quality Of Care Referral Policy	05/17/2021	QM6022
Quality Of Care Referral Procedure	05/17/2021	QM6022-1
Samhsa Block Grant-annual Program Review Procedure	05/17/2021	QM6024
Fee-for Service Credentialing Procedure	05/17/2021	QM6026
Dbh Provider Directories Policy	05/17/2021	QM6027
Grievance and Appeal Policy	09/19/2022	QM6029
Grievance Procedure	05/17/2021	QM6029-1
State Hearing Procedure	05/17/2021	QM6029-2
Standard And Expedited Resolution Of Appeals Procedure	05/17/2021	QM6029-3
Noabd Procedure	05/17/2021	QM6029-4
Research Policy	05/17/2021	QM6032
Service Delivery Definition Policy	05/17/2021	QM6036
Consistency in Inpatient and Outpatient Utilization Review and Authorization Practices Policy	07/19/2022	QM6038
Consistency in Inpatient Utilization Review and Authorization Practices Procedure	07/19/2022	QM6038-1
Consistency in Outpatient Utilization Review and Authorization Practices Procedure	07/19/2022	QM6038-2
Mhp Point Of Authorization Plan For Inpatient Psychiatric Hospitalization Protocol	05/17/2021	QM6039
Tier Transition Protocol	05/17/2021	QM6040
Timely Access Procedure	08/18/2022	QM6041-1
Timely Access Policy	07/19/2022	QM6041
Network Adequacy Procedure	05/17/2021	QM6043-1
Out of Network Policy	07/18/2022	QM6044
Out of Network Access Procedure	07/18/2022	QM6044-1
24/7 Access Line Requirements Policy	07/20/2022	QM6045
24/7 Access Line Requirements Procedure	07/20/2022	QM6045-1
Service Availability Policy	07/19/2022	QM6046
Selection And Retention Of Network Provider Policy	05/17/2021	QM6048
Department Liability For Employees And Volunteers’ Action Outside Work	05/18/2021	SFT7002
Bomb Threat Procedure	05/18/2021	SFT7005
Earthquake Procedures	05/18/2021	SFT7006
Disaster And Mass Casualty Policy	05/18/2021	SFT7007
Air Pollution Emergency Episode Plan	05/18/2021	SFT7008
Assaultive Behavior Plan (abp) Policy	05/18/2021	SFT7009
Possession of a Weapon Policy	07/05/2024	SFT7010
Assaultive Behavior Plan (abp) Procedure	05/18/2021	SFT7009-1
Possession of a Weapon Procedure	07/05/2024	SFT7010-1
Safety And Emergency Coordination Policy	05/18/2021	SFT7011
Electrical Safety Policy: Personal Appliances	05/18/2021	SFT7012
Safety In The Field Procedure	05/18/2021	SFT7013
Threats Against Federal Or State Officials Policy	05/18/2021	SFT7014
Threats and Assault on DBH Staff Policy		SFT7015
Threats And Assault On Dbh Staff Procedure	05/18/2021	SFT7015-1
Special Incident Reporting Procedure – Client Related	05/18/2021	SFT7016
How To Report An Incident	05/18/2021	SFT7017
Hazard Reporting Policy	05/18/2021	SFT7018
Vehicle Accidents Reporting Procedure	05/18/2021	SFT7019
Occupational Injury or Illness Reporting Procedure		SFT7020
Employee General Safety Policy	05/18/2021	SFT7021
Emergency Action Plan (eap) Policy	05/18/2021	SFT7022
Disaster Equipment Security Policy	05/18/2021	SFT7023
Kiln Policy	05/18/2021	SFT7024
Local Community Crisis Incident Response Procedure	05/18/2021	SFT7028
Office Ergonomics Intervention Program Policy	05/18/2021	SFT7029
Interagency Communication Of Unusual Events Procedure	05/18/2021	SFT7032
Education and Training Policy	10/19/2021	TRA8001
Executive Training Committee Policy	05/18/2021	TRA8003
Training Payment Procedure	05/18/2021	TRA8004
Training Attendance Policy	05/18/2021	TRA8005
Training Tuition Reimbursement Policy	05/18/2021	TRA8006
Training Tuition Reimbursement Procedure	05/18/2021	TRA8006-1
Training Coordination Policy	05/18/2021	TRA8008
Training Coordination Procedure	09/29/2021	TRA8008-1
License Exam Prep Program Policy	05/18/2021	TRA8010
Bilingual Certification Policy	08/24/2021	HR4031
Request for Second Opinion QM6053 New!	08/24/2021	QM6053
Request for Second Opinion Procedure QM6053-1 New!	08/24/2021	QM6053-1
SUDRS Master Provider File Procedure	09/07/2021	SUDRS0238
Substance Use Disorder and Recovery Services Policy	09/07/2021	SUDRS0207
Substance Use Disorder and Recovery Services Procedure	09/07/2021	SUDRS0207-1
Naloxone Intranasal Distribution Policy	03/20/2023	MDS2032
Naloxone Intranasal Distribution Procedure	03/20/2023	MDS2032-1
Advance Health Care Directive	09/23/2021	COM005
Remote Access Policy	09/28/2021	IT5006
Client Tuberculosis (TB) Testing and Services Policy	11/03/2021	SUDRS0219
Client Tuberculosis (TB) Testing and Services Procedure	11/03/2021	SUDRS0219-1
myAvatar Electronic Health Records Policy	12/15/2021	IT5012
myAvatar User Account Request Procedure	12/15/2021	IT5012-1
myAvatar User Account Creation and Reinstatement Procedure	12/15/2021	IT5012-2
myAvatar User Account Modification Procedure	12/15/2021	IT5012-3
myAvatar User Account Deactivation Procedure	12/15/2021	IT5012-4
Criteria for Beneficiary Access to SMHS Medical Necessity and other Requirements	06/14/2022	QM6054
Medication Support Only Case Policy	06/22/2022	MDS2009
No Wrong Door for Mental Health Services Policy	07/01/2022	QM6055
Test Call Policy	07/20/2022	QM6057
Fentanyl Test Strips Project Policy	11/30/2022	SUDRS0243
Fentanyl Test Strips Project Procedure	11/30/2022	SUDRS0243-1
Privacy/Security Incident Report		HSPSP 1503
County Behavioral Health Intergovernmental Transfers (IGT)	08/28/2023	BOP3050
Contingency Management: Recovery Incentives Program Policy	09/08/2023	SUDRS0248
Contingency Management: Recovery incentives Program Monitoring Procedure	09/08/2023	SUDRS0248-1
Contingency Management: Recovery Incentives Provider Procedure	09/08/2023	SUDRS0248-2
Contingency Management: Recovery Incentives Program Urine Drug test (UDT) Procedure	09/08/2023	SUDRS0248-3
Adolescent SUD Best Practices	09/14/2023	SUDRS0247
Pre-Award Financial Risk Assessment Procedure	09/26/2023	SUDRS0246-1
Pre-Award Financial Risk Assessment Policy	09/26/2023	SUDRS0246
Electroconvulsive Therapy (ECT) Referral and Payment Authorization Policy	01/17/2024	MDS2026
Electroconvulsive Therapy (ECT) Referral and Payment Authorization Procedure	01/17/2024	MDS2026-1
Contract Provider Audit Appeal Policy	04/07/2025	BOP3052
Contract Provider Audit Appeal Procedure	04/07/2025	BOP3052-1
Access and Amendment of Medical Records Procedure	05/22/2025	COM0931-1
Medical Record Document Corrections in myAvatar Policy	07/08/2025	COM0960
Medical Record Document Corrections in myAvatar Procedure	07/08/2025	COM0960-1

Name	Modified Date	Notice Number
My Avatar ICL Update	06/05/2024	IN 23-04
Notice to Patients	04/04/2023	IN 23-01
DBH and BBS Complaint Notification to Client	07/16/2024	IN 23-03
Status of COVID-19 Emergency Health Care Flexibilities	04/03/2023	IN 23-02
Evaluation Code Changes	01/21/2021	IN 20-09
Revised Mental Health Co-Staffing Chart Documentation a	07/01/2020	IN 20-07
Personal Protective Equipment (PPE) for DBH Programs	06/01/2020	IN 20-06
Quality Management Chart Documentation Guidance due to	05/01/2020	IN 20-05
A1 DUI Guidance due to COVID-19	05/01/2020	IN 20-05
A2 NTP Guidance due to COVID-19	05/01/2020	IN 20-05
Administration Guidance due to COVID-19	05/01/2020	IN 20-05
New Classification of Other Qualified Providers	02/01/2020	IN 20-02
Suicide Prevention Training Requirement	01/01/2020	IN 20-01
Coronavirus (COVID-19) Information for DBH Workforce	08/11/2021	IN 20-04
Mental Health Consumer Perception Survey – Spring 2019	08/12/2021	IN 19-01
DMC-ODS UCLA Treatment Perception Survey-October 2019	08/12/2021	IN 19-02
Notice of Changes to EPSDT Data Collection Requirements	08/12/2021	IN 19-04
Approved Abbreviations New!	08/12/2021	IN 19-05
Editing Notice of Adverse Benefit Determination (NOABD)	08/12/2021	IN 19-06
Mental Health Consumer Perception Survey-Fall 2019 New!	08/12/2021	IN 19-07
Consolidation of Electronic Signature (E-Signature)	08/12/2021	IN 19-08
New Medicare Beneficiary Identifier (MBI) New!	08/12/2021	IN 19-09
Network Adequacy Requirements and Deadline (03/01/2018)	08/12/2021	IN 18-01
Updated Authorization to Release Protected Health Info	08/12/2021	IN 18-02
Child and Adolescent Needs and Strengths (CANS)(PSC-35)	08/12/2021	IN 18-03
UCLA Treatment Perceptions Survey Information (9/20/18)	08/12/2021	IN 18-04
Mental Health Consumer Perception Survey – Fall 2018	08/12/2021	IN 18-05
Office Configuration Safety Standards (12/18/2018) New!	08/12/2021	IN 18-06
Standing Order Requirement for Administering NARCAN	08/12/2021	IN 18-08
Disaster Response Requirements (02/01/2017) New!	08/12/2021	IN 17-01
Revised Child/Adolescent Psychiatric Evaluation CLP014	08/12/2021	IN 17-02
SIMON Update (03/01/2017) New!	08/12/2021	IN 17-03
Regulations Regarding Welfare and Institutions Code WIC	08/12/2021	IN 17-05
CLP015-1 Child/Adolescent Assessment-CANS-SB 05/02/2017	08/12/2021	IN 17-07
Implementation of the Diagnostic and Statistical Manual	08/12/2021	IN 17-09
Medicaid Managed Care Final Rule Implementation	08/12/2021	IN 17-10
Confidentiality Statement Requirement for Safeguarding	08/12/2021	IN 17-11
Oath of Confidentiality (Contractors)	01/14/2022	IN 17-11 Appendix A
Implementation of Title Change of Marriage and Family	08/12/2021	IN 17-12
Psychiatric Mental Health Nurse Practitioners	08/12/2021	IN 17-14
New Mental Health Procedure Codes (10/13/2016)	08/12/2021	IN 16-03
Outpatient Chart Manual and Scope of Practice Guide	08/12/2021	IN 16-02
Contact by Outside State or Federal Agencies	08/12/2021	IN 14-12
Breining Institute Accreditation Termination	08/12/2021	IN 14-11
Guidelines for Day Treatment Intensive	08/12/2021	IN 14-10
Updates to the Scope of Practice and Billing Guide	08/12/2021	IN 14-06
Updated DBH Billing Forms and Reference Materials	08/12/2021	IN 14-09
Medi-Cal Expansion-Determining Tier III Service	08/12/2021	IN 14-05
ICD-10 Implementation Delayed (04/03/2014)	08/12/2021	IN 14-08
Medicare Updates Regarding ICD-10 (02/20/2014)	08/12/2021	IN 14-01
Medi-Cal Expansion (02/11/2014)	08/12/2021	IN 14-03
Updates to the Scope of Practice and Billing Guide	08/12/2021	IN 14-02
Discontinuance of Procedure Code 365 (11/05/2015)	08/12/2021	IN 15-02
Non-use of Blood Glucometers (06/02/2015)	08/12/2021	IN 15-01 Non-use of Blood Glucometers (06/02/2015)
CDPH Orders for Behavioral Health Facilities u0026amp; Workers	09/10/2021	IN 21-03
Flexibilities for Medicare Telehealth Services	12/01/2021	IN 21-02
Chart Entry to Address Provider Professional Credentials	12/02/2021	IN 21-04
Threshold Languages	09/19/2022	IN 22-01

Name	Modified Date	Modified By
Treatment Prior to Assessment Period	01/17/2023	IIN 22-003
Documentation of Co-Occurring Disorders	03/10/2023	IIN 22-002
New Timeframes for Completion of Progress Notes	01/17/2023	IIN 22-001
myAvatar Chart Documentation Procedural Changes (IIN 21-002)	11/09/2021	IIN 21-002
Network Adequacy Certification Tool (NACT) (07/01/2020)	08/12/2021	IIN 20-001
Ergonomic Assessment Level (12/12/2018) New!	08/12/2021	IIN 18-001
e-Prescribing Chart Documentation (12/07/2016) New!	08/12/2021	IIN 16-001
Reporting Medical Conditions and Communicable Diseases	08/12/2021	IIN 16-002
Pill Organizers for DBH Clients (11/06/2015)	08/12/2021	IIN 15-003
ICD-10 Diagnosis and Procedure Code Transition	08/12/2021	IIN 15-002
State Requirements for Treatment Authorization Requests	08/12/2021	IIN 14-004
Electrical Safety: Personal Appliances (04/11/2014)	08/12/2021	IIN 14-002
Medication Policy and Procedure (11/20/2013)	08/12/2021	IIN 13-002
Microsoft LYNC (02/19/2013)	08/12/2021	IIN 12-006
Prepaid Debit Cards/Bus Pass Continuous Written Log	08/12/2021	IIN 12-004
Email Encryption (06/30/2011)	08/12/2021	IIN 11-002
Use of Electronic Signatures (04/22/2010)	08/12/2021	IIN 10-003
Disaster and Safety Unit (04/01/2010)	08/12/2021	IIN 10-002
Red Flags Rule (05/04/2009)	08/12/2021	IIN 09-002
Use of Episode Closing Codes (03/02/2009)	08/12/2021	IIN 09-001

Name	Modified Date	Program and Number
CalAIM Place of Service Codes Descriptions	05/01/2025
Consent for Treatment of Minors FAQs	05/13/2025
Certified and Uncertified Peer Support Specialist Job Aid	05/27/2025
DBH Confidentiality Privacy and Security Training	02/25/2025
CalAIM FAQs (August – October 2024)	12/02/2024
Confidentiality Privacy and Security Compliance Training FAQs	04/16/2025
CalAIM Service Code Listing (MHS127) Job Aid	11/26/2024
DBH MH Service Table (FY 24-25)
Mode and Service Function Information	12/20/2021	Fiscal
How to Document – ICL Form	06/05/2024
ICL Cheat Sheet	06/05/2024
PEI Modes of Service	12/20/2021	Fiscal
CalAIM Place of Service Codes Descriptions	08/26/2024
CalAIM Documentation/ IT Revenue Cycle Updates	06/27/2024
CalAim Documentation u0026amp; Coding Training – SUD	06/27/2024
CalAim Documentation u0026amp; Coding Training – Mental Health	06/27/2024
DHCS CalAIM Service Tables – Mental Health u0026amp; SUD	07/02/2024
CalAIM Coding – Documentation – IT – Revenue Cycle Updates	03/26/2025
CalAIM Codes for DBH Providers Guidance	11/18/2024

Spring 2025 Consumer Perception Survey Training

Click Here to Visit Relias Learning
Contact DBH Workforce Education and Training at (800) 722-9866 for any questions regarding your Relias Learning account, password, or access.

Online Surveys:

Paper Surveys:

Adult QOL English/Spanish/Mandarin/Vietnamese
Older Adult QOL English/Spanish/Mandarin/Vietnamese
Youth (YSS) English/Spanish/Mandarin/Vietnamese
Families of Youth (YSS-F) English/Spanish/Mandarin/Vietnamese
For Surveys in additional languages, please visit the UCLA website. Then select the survey titled “Adult + Quality Of Life,” “Older Adult + Quality Of Life,” “Youth,” or “Families of Youth.” Please note: County Codes are not prefilled on the UCLA website.

If the client refuses to participate use the Refusal link. You may also find the refusal link at the UCLA website under the section titled Recording Reason Codes.

CPS Flyer Templates:

CPS Flyer Adult English/Spanish/Mandarin/Vietnamese
CPS Flyer Older Adult English/Spanish/Mandarin/Vietnamese
CPS Flyer Youth & Family English/Spanish/Mandarin/Vietnamese
For flyers in Farsi, please visit the UCLA website

Additional Files: