Documents Departmental FormsDepartmental FormsStandard Practice ManualStandard Practice ManualInformation NoticesInformation NoticesInterim Instruction NoticesInterim Instruction NoticesResourcesResourcesFor ProvidersFor Providers Type Name Modified Date Program and Number Actions 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 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 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 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 Translation Service Request Form 08/16/2022 CUL002 Interpretation Service Request Form 08/16/2022 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 Electronic Signature Request Checklist 08/03/2022 COM043 Out of Network Services Request 07/12/2022 QM039 Beneficiary Nondiscrimination Notice (Mandarin)” 07/28/2022 QM026_M Beneficiary Nondiscrimination Notice (Vietnamese) 07/28/2022 QM026_V Your Rights Attachment (NOABD) (Mandarin) 07/28/2022 QM024_M Your Rights Attachment (NOABD) (Vietnamese) 07/28/2022 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 05/09/2022 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 SUDRS046 CalOMS Admission Instructions SUDRS047 CalOMS Standard Discharge SUDRS048 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 09/26/2023 Staff Master Worksheet Update Staff Master Worksheet 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 Notice of Personal Rights / Civil Rights 01/31/2023 SUDRS003_E Notice of Personal Rights / Civil Rights (Spanish) 01/31/2023 SUDRS003_S Notice of Personal Rights / Civil Rights (Mandarin) 01/31/2023 SUDRS003_M Notice of Personal Rights / Civil Rights (Vietnamese) 01/31/2023 SUDRS003_V Client Admission Agreement 05/10/2021 SUDRS022_E Client Admission Agreement (Spanish) 05/10/2021 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 07/19/2023 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 05/18/2022 SUDRS031 Adolescent (Age 12-17) and Young Adult (Age 18-20) DMC-ODS Transition New! 05/10/2021 SUDRS033 SUD Referral 07/20/2022 SUDRS034 Recovery Services Plan 05/10/2021 SUDRS039 Level of Care (LOC) 05/10/2021 SUDRS042 CalOMS Youth-Detox Discharge 05/10/2021 SUDRS050 CalOMS Admission (Outpatient) 05/10/2021 SUDRS051 CalOMS Annual Update 05/10/2021 SUDRS052 Children’s Interagency Authorization to Exchange Confidential Health Information (PHI) Superseded by COM025_E 05/11/2021 CHD_INTER_E Children’s Interagency Authorization to Exchange Confidential Health Information (PHI) (Spanish) Superseded by COM025_S 05/11/2021 CHD_INTER_S 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 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 Universal Charge Data Invoice 06/13/2022 CLP006 Charge Data Invoice 02/15/2022 CLP009 Client Resource Evaluation 02/15/2022 CLP012 Adult Psychiatric Evaluation (Fillable) 02/15/2022 CLP013 (Fill) Adult Psychiatric Evaluation (Fillable) 02/15/2022 CLP013 (Print) Child/Adolescent Psychiatric Evaluation and Update 05/11/2021 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 02/15/2022 CLP027 Services Teams Actions 05/17/2023 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 Form 03/02/2022 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 Interdisciplinary Care Team (ICT) Referral Form 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) 05/11/2021 QM024_E Your Rights Attachment (NOABD) (Spanish) 05/11/2021 QM024_S Your Rights Attachment (NAR) 05/11/2021 QM025_E Your Rights Attachment (NAR) (Spanish) 05/11/2021 QM025_S Beneficiary Nondiscrimination Notice 03/10/2023 QM026_E Beneficiary Nondiscrimination Notice (Spanish) 05/11/2021 QM026_S Language Assistance Taglines 03/10/2023 QM027_E Delivery System Notice (NOABD) (Vietnamese)” 07/27/2022 QM029_V Delivery System Notice (NOABD) 07/28/2022 QM029_E Delivery System Notice (NOABD) (Spanish) 07/28/2022 QM029_S Delivery System Notice (NOABD) (Mandarin) 07/27/2022 QM029_M Modification Notice (NOABD) 07/28/2022 QM030_E Modification Notice (NOABD) (Mandarin) 07/27/2022 QM030_M Modification Notice (NOABD) (Vietnamese) 07/27/2022 QM030_V QM030_S “Modification Notice (NOABD) (Spanish) 07/28/2022 QM030_S Change Order Request Routing Slip 05/11/2021 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) 07/27/2022 QM058_V Denial Notice (NOABD) (Mandarin) 07/27/2022 QM058_M Denial Notice (NOABD) 07/28/2022 QM058_E Denial Notice (NOABD) (Spanish) 07/28/2022 QM058_S Termination Notice (NOABD) 05/11/2021 QM059_E Termination Notice (NOABD) (Spanish) 05/11/2021 QM059_S Timely Access Notice (NOABD) 07/28/2022 QM061_E Timely Access Notice (NOABD) (Spanish) 07/28/2022 QM061_S Timely Access Notice (NOABD) (Mandarin) 07/27/2022 QM061_M Timely Access Notice (NOABD) (Vietnamese) 07/27/2022 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) 07/28/2022 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 CSI Assessment 05/11/2021 CLK029 myAvatar CSI Assessment (Spanish) 05/11/2021 CLK029_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) 08/09/2021 COM001_E Authorization to Release Protected Health Information (PHI) (Spanish) 08/23/2021 COM001_S Authorization to Release Protected Health Information (PHI) (Vietnamese) 09/15/2021 COM001_V Code of Conduct and Code of Conduct Acknowledgement 05/11/2021 COM003 Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices 10/19/2022 COM004_E Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (Spanish) 05/11/2021 COM004_S 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 07/27/2022 COM020 Access to Medical Records Request 05/11/2021 COM021_E Access to Medical Records Request (Spanish) 05/11/2021 COM021_S Response to Request to Access Medical Records 05/11/2021 COM022_E Response to Request to Access Medical Records (Spanish) 05/11/2021 COM022_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 Internal Tracking of Request to Access Medical Records 05/11/2021 COM025 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 05/11/2021 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 DBH & BBS Complaint Notifications to Clients (8-20) 05/11/2021 COM040_E DBH & BBS Complaint Notifications to Clients (8-20) (Spanish) 05/11/2021 COM040_S myAvatar Policy/Procedure Acknowledgement Form 12/27/2022 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 11/22/2021 SUDRS024 Payment Denial Notice 11/22/2021 QM060_E Payment Denial Notice (Spanish) 11/22/2021 QM060_S Authorization Delay Notice 11/22/2021 QM033_E Authorization Delay Notice (Spanish) 11/22/2021 QM033_S Grievance and Appeal Timely Resolution Notice 11/22/2021 QM062_E Grievance and Appeal Timely Resolution Notice (Spanish) 11/22/2021 QM062_S Unusual Occurrence/Incident Report 04/07/2022 QM053 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 09/21/2023 SUDRS054 Type Name Modified Date Program and Number Antidepressant Prescribing Guidelines 06/28/2023 MDS2035 Sedative Hypnotics Practice Guidelines 06/28/2023 MDS2037 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 04/27/2023 MDS2033-2 Clinical Laboratory Registration Procedure 04/27/2023 MDS2033-1 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 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 DBH-IT Data Encryption 02/28/2022 IT5018 DATAR Policy (SUDRS0236) 08/29/2023 SUDRS0236 DATAR Procedure (SUDRS0236-1) 08/28/2023 SUDRS0236-1 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 Scope of Practice Billing Guide 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 Alcohol and Drug Services Code of Professional Conduct Policy 05/13/2021 ADS0202 Title 22 Fair Hearing Rights Policy 05/13/2021 ADS0205 Charitable Choice Procedure 10/06/2021 SUDRS0209-1 Medication Policy for Clients Seeking Alcohol and Drug Treatment Services 05/13/2021 ADS0210 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 Expenditure of the Substance Abuse Prevention and Treatment Block Grant Policy 05/13/2021 ADS0221 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 Measurement System 05/13/2021 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 Children’s Fund Immediate Need Voucher Procedure 05/13/2021 CHD0315-1 Consent for Treatment of Minors Policy 05/13/2021 CHD0316 Consent to Treat a Minor: Procedures for Parents/Legal Guardians 05/13/2021 CHD0316-1 Consent to Treat a Dependent Minor Procedure 05/13/2021 CHD0316-2 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 Charge Data Invoice (CDI) Process 03/23/2023 CLK0704 Scheduling Application Policy 05/13/2021 CLK0705 Correction of Overlapping Service 05/13/2021 CLK0707 Service Deletions and Corrections 05/13/2021 CLK0708 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 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 Confidentiality When Dealing with Client Support Persons 05/13/2021 CLP0825 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 05/13/2021 COM0902 Advance Health Care Directive Policy 05/13/2021 COM0903 Medical Record Security Policy for Outpatient Services 08/30/2022 COM0904 Confidentiality of Protected Health Information (PHI) 05/13/2021 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 Electronic Transfer of Client PHI 05/13/2021 COM0909 HIPAA Notice of Privacy Practices (NOPP) Policy 10/17/2022 COM0910 Conflict of Interest Policy 07/27/2022 COM0911 Authorization to Release PHI Policy 08/09/2021 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 05/13/2021 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 Workstation and System Security Policy 05/13/2021 COM0924 Data Integrity Policy 05/13/2021 COM0925 Privacy and Security Incident Sanctions 01/19/2022 COM0926 Fraud, Waste and Abuse Prevention Policy 05/13/2021 COM0927 Access and Amendment of Medical Records Policy 05/13/2021 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 Systems (MEDS) Policy 05/13/2021 COM0943 MEDS Access and Contacts Procedure 05/13/2021 COM0943-1 Privacy Incident Policy 10/25/2022 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 Non-Discrimination of Clients (Affordable Care Act) Policy (COM0953) Rev. 11-22 COM0953 Affordable Care Act (ACA) 1557 Grievance Procedure 05/13/2021 COM953-1 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 05/17/2021 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 Medication Appointment – Scheduling 05/17/2021 MDS2011 Sample Injectable Medication Policy 05/17/2021 MDS2012 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 05/17/2021 MDS2027 Telehealth Procedure 05/17/2021 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 Assignment of Pagers to Divisions/Programs and Staff 05/17/2021 BOP3021 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 Employee Recognition Policy 05/17/2021 BOP3037 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 03/27/2023 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 05/17/2021 HR4016 Disability Discrimination Complaints 05/17/2021 HR4017 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 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 Request for Information Technology Support Procedure 05/17/2021 IT5002 Internet Access policy 05/17/2021 IT5003 IT5004 Computer and Network Appropriate Use Policy 08/29/2023 IT5004 Electronic Mail Use Policy 05/17/2021 IT5005 Risk Assessment Policy 05/17/2021 IT5007 Device and Media Controls Policy 05/17/2021 IT5008 User- I.D. and Password Policy 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 Assaultive Behavior Plan (ABP) Procedure 05/18/2021 SFT7009-1 Possession of a Weapon Policy 05/18/2021 SFT7010 Possession of a Weapon Procedure 05/18/2021 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 05/18/2021 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 09/07/2021 MDS2032 Naloxone Intranasal Distribution Procedure 09/07/2021 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 SUDRS2043-1 Information Breach – Standard Practice HSPSP 15-2 Security and Privacy Representatives HSPSP 1505 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 SUDRS2048 Contingency Management: Recovery incentives Program Monitoring Procedure 09/08/2023 SUDRS2048-1 Contingency Management: Recovery Incentives Provider Procedure 09/08/2023 SUDRS2048-2 Contingency Management: Recovery Incentives Program Urine Drug test (UDT) Procedure 09/08/2023 SUDRS2048-3 Adolescent SUD Best Practices 09/14/2023 SUDRS2047 Pre-Award Financial Risk Assessment Procedure 09/26/2023 SUDRS0246-1 Pre-Award Financial Risk Assessment Policy 09/26/2023 SUDRS0246 Type Name Modified Date Notice Number Notice to Patients 04/04/2023 IN 23-01 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 Revised Medicare Certification Requirement (01/29/2016) 08/12/2021 IN 11-04 Electronic Mail (e-mail) Encryption (11/19/2015) 08/12/2021 IN 15-04 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 Updates to the Lanterman-Petris-Short (LPS) Act 08/12/2021 IN 13-13 Diagnostic and Statistical Manual of Mental Disorder 08/12/2021 IN 13-15 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) Marriage and Family Therapist Intern Experience 08/12/2021 IN 13-10 Board of Behavioral Sciences (BBS) Amendments 08/12/2021 IN 13-09 Care Necessity Form – Revision (09/13/2013) 08/12/2021 IN 13-08 Medicare Administrative Contract Transition 07/15/2013 08/12/2021 IN 13-07 Mental Health Plan (MHP) Contract Clarifications 08/12/2021 IN 13-05 Client Index Number (CIN) Policy Enforcement 07/02/2013 08/12/2021 IN 13-06 DBH Library Protocol (05/08/2013) 08/12/2021 IN 13-03 Accreditation of Certifying Organizations (04/30/2013) 08/12/2021 IN 13-04 Disclosure of Ownership (03/18/2013) 08/12/2021 IN 13-01 Disclosure of Ownership (03/18/2013) Changes in Charge Data Invoice (CDI) Codes (12/27/2012) 08/12/2021 IN 12-05 Outpatient Chart Manual/Initial Contact Form 12/20/2012 08/12/2021 IN 12-06 License Denied or Suspended for Failure to Pay Taxes 08/12/2021 IN 12-02 Clinical Re-Assessment (07/24/2012) 08/12/2021 IN 12-03 Requirements for Lactation Accommodations (01/06/2012) 08/12/2021 IN 12-01 Board Referral of Matters to County Staff (10/26/2011) 08/12/2021 IN 11-17 Authorization of Release of Protected Health Info 08/12/2021 IN 11-13 Sharing of Protected Health Information relating to MH 08/12/2021 IN 11-11 Medi-Cal Claims Processing Requirements When Other 08/12/2021 IN 11-10 Scope of Practice and Billing Guide (05/17/2011) 08/12/2021 IN 11-07 Updates to Universal Chart Data Invoice (CDI) Codes 08/12/2021 IN 11-06 Outpatient Chart Manual (OCM) Revision (05/09/2011) 08/12/2021 IN 11-08 Assembly Bill (AB) 583 (01/18/2011) 08/12/2021 IN 11-02 Medi-Cal Eligibility System (MEDS) (01/18/2011) 08/12/2021 IN 11-01 Generic Medication (11/19/2010) 08/12/2021 IN 10-15 Sanctions for Certification of Excluded, Suspended 08/12/2021 IN 10-14 JAG-OTP Funds (08/11/2010) 08/12/2021 IN 10-10 Adhering to Educational Regulations (05/26/2010) 08/12/2021 IN 10-08 Providing Written Communication to Consumers/Family 08/12/2021 IN 10-07 Medicare: Forms Update u0026amp; Review Process (03/01/2010) 08/12/2021 IN 10-05 Certification of Alcohol and Other Drug (AOD) Counselor 08/12/2021 IN 10-04 Simon Update for Short Doyle/Medi-Cal Phase II 08/12/2021 IN 10-03 Approval of Promotional, Educational and/or Information 08/12/2021 IN 09-11 Outpatient Chart Manual (04/08/2009) 08/12/2021 IN 09-10 Referral of Clients from Contract Agencies 08/12/2021 IN 09-06 Health Family SED Services Policy/Procedures 02/11/2009 08/12/2021 IN 09-03 Practice and Billing Guide (02/01/2009) 08/12/2021 IN 09-02 Outpatient Chart Manual (OCM) Changes (01/26/2009) 08/12/2021 IN 09-01 Inpatient Claims for Medi-Cal Recipients with other 08/12/2021 IN 08-07
