Type Name Modified Date Program and Number Actions
pdf Change of Provider Request Form – 18pt. font (Spanish) 06/28/2022 QM047_S
pdf Translation Service Request Form 08/16/2022 CUL002
pdf Interpretation Service Request Form 08/16/2022 CUL006
pdf Opioid Agreement for Buprenorphine Medication Assisted Treatment (Spanish) 08/02/2022 SUDRS040_S
pdf Opioid Agreement for Buprenorphine Medication Assisted Treatment (English) 08/02/2022 SUDRS040_E
pdf Electronic Signature Request Checklist 08/03/2022 COM043
pdf Out of Network Services Request 07/12/2022 QM039
docx Beneficiary Nondiscrimination Notice (Mandarin)” 07/28/2022 QM026_M
docx Beneficiary Nondiscrimination Notice (Vietnamese) 07/28/2022 QM026_V
docx Your Rights Attachment (NOABD) (Mandarin) 07/28/2022 QM024_M
docx Your Rights Attachment (NOABD) (Vietnamese) 07/28/2022 QM024_V
pdf Change of Provider Request Form – 18pt. font (English) 06/28/2022 QM047_E
pdf Code of Professional Conduct for Drug and Alcohol Staff 05/05/2022 SUDRS001
pdf Adolescent (Age 12-17) and Young Adult ASAM TRIAGE LEVEL OF CARE SCREENING – Instructions 05/09/2022 SUDRS044
pdf Consent for SUD Care Coordination Services (Spanish) SUDRS035_S
pdf Care Coordination Needs Determination Screening Tool (English) SUDRS036_E
pdf SUD Care Coordination Needs Determination Screening Tool (Spanish) SUDRS036_S
pdf SUD Care Coordination Plan (English) SUDRS037_E
pdf SUD Care Coordination Plan (Spanish) SUDRS037_S SUD
pdf Care Coordination Discharge Summary (English) SUDRS038_E
pdf Care Coordination Discharge Summary (Spanish) SUDRS038_S
pdf CalOMS Administrative Discharge SUDRS045
pdf CalOMS Admission SUDRS046
pdf CalOMS Admission Instructions SUDRS047
pdf CalOMS Standard Discharge SUDRS048
pdf CalOMS Standard Discharge Instructions SUDRS049
pdf Privacy and Security Incident Reporting Form 05/03/2022 COM042
pdf Medi Cal Fee For Service Provider Manual MHPFFS51319
pdf Taxonomy Codes 09/16/2021
Staff Master Worksheet Update
Staff Master Worksheet
pdf Mental Health Professional Licensing Waiver Request 05/10/2021 DHCS 1739
pdf Title 22 Fair Hearing Rights 09/23/2021 ADS002_E
pdf Title 22 Fair Hearing Rights (Spanish) 05/10/2021 ADS002_S
pdf Notice of Personal Rights / Civil Rights 08/03/2022 SUDRS003_E
pdf Notice of Personal Rights / Civil Rights – Spanish 08/03/2022 SUDRS003_S
pdf Client Admission Agreement 05/10/2021 SUDRS022_E
pdf Client Admission Agreement (Spanish) 05/10/2021 SUDRS022_S
pdf Substance Use Disorder and Recovery Services Intake Ass 05/10/2021 SUDRS025
pdf Adult (Age 21 and Over) DMC-ODS Transition SUDRS026
pdf Immediate Need Profile 05/06/2022 SUDRS027
pdf Adult (21+) ASAM Level of Care Screening 05/18/2022 SUDRS028
pdf Handbook Summary and Acknowledgement Form (English) 05/10/2021 SUDRS029_E
pdf Handbook Summary and Acknowledgement Form (Spanish) 05/10/2021 SUDRS029_S
pdf SUDRS-MH Grievance and Appeals Process Brochure (English) 05/10/2021 SUDRS030_E
pdf SUDRS-MH Grievance and Appeals Process Brochure (Spanish) 05/10/2021 SUDRS030_S
pdf SUDRS-MH Grievance and Appeals Process Brochure- 18pt. font (Spanish) 05/10/2021 SUDRS030_S
pdf SUDRS-MH Grievance and Appeals Process Brochure-18pt. font (English) SUDRS030_E
pdf Adolescent (Age 12-17) and Young Adult ASAM Level of Care Screening 05/18/2022 SUDRS031
pdf Adolescent (Age 12-17) and Young Adult (Age 18-20) DMC-ODS Transition New! 05/10/2021 SUDRS033
pdf SUD Referral 07/20/2022 SUDRS034
pdf Recovery Services Plan 05/10/2021 SUDRS039
pdf Level of Care (LOC) 05/10/2021 SUDRS042
pdf CalOMS Youth-Detox Discharge 05/10/2021 SUDRS050
pdf CalOMS Admission (Outpatient) 05/10/2021 SUDRS051
pdf CalOMS Annual Update 05/10/2021 SUDRS052
pdf Children’s Interagency Authorization to Exchange Confidential Health Information (PHI) Superseded by COM025_E 05/11/2021 CHD_INTER_E
pdf Children’s Interagency Authorization to Exchange Confidential Health Information (PHI) (Spanish) Superseded by COM025_S 05/11/2021 CHD_INTER_S
pdf Therapeutic Behavioral Services Service Assessment 05/11/2021 CHD012
pdf Therapeutic Behavioral Services Risk Assessment 05/11/2021 CHD013
pdf Therapeutic Behavioral Services Referral Form 05/11/2021 CHD014
pdf Children’s Interagency Authorization to Exchange Confidential Health Information (PHI) 05/11/2021 CHD025_E
pdf Children’s Interagency Authorization to Exchange Confidential Health Information (PHI) (Spanish) 05/11/2021 CHD025_S
pdf Episode Opening and Closing Codes 05/11/2021 CLP_CODES
pdf Client Payment Agreement 05/11/2021 CLP001
pdf Client Episode Summary (CSI) 05/11/2021 CLP002
pdf Initial Contact Form (English) 08/26/2021 CLP003_E
pdf Initial Contact Form (Spanish) 05/11/2021 CLP003_S
pdf CSI Periodic Data 05/11/2021 CLP004
pdf Adult Clinical Assessment (A-1) 05/11/2021 CLP005
pdf Universal Charge Data Invoice 06/13/2022 CLP006
pdf Charge Data Invoice 02/15/2022 CLP009
pdf Client Resource Evaluation 02/15/2022 CLP012
pdf Adult Psychiatric Evaluation (Fillable) 02/15/2022 CLP013 (Fill)
pdf Adult Psychiatric Evaluation (Fillable) 02/15/2022 CLP013 (Print)
pdf Child/Adolescent Psychiatric Evaluation and Update 05/11/2021 CLP014
pdf Child/Adolescent Clinical Assessment 05/11/2021 CLP015
pdf Child/Adolescent Clinical Assessment-CANS-SB 05/11/2021 CLP015-1
pdf Physical Assessment 05/11/2021 CLP016_E
pdf Physical Assessment (Spanish) 05/11/2021 CLP016_S
pdf Client Recovery Evaluation (Annual) 05/11/2021 CLP017
pdf Request to Waive Consumer’s Responsibility to Pay for Medications 05/11/2021 CLP018
pdf Care Necessity 05/11/2021 CLP019
pdf Psychological Testing Referral Form 04/13/2022 CLP020
pdf Healthy Homes Screening/Assessment 05/11/2021 CLP021
pdf Diagnosis 05/11/2021 CLP022
pdf Client Recovery Plan/ISSP 05/11/2021 CLP024_E
pdf Client Recovery Plan/ISSP (Spanish) 05/11/2021 CLP024_S
pdf Discharge Summary 05/11/2021 CLP025
pdf Abnormal Involuntary Movement Scale 05/11/2021 CLP026
pdf Interdisciplinary Note 02/15/2022 CLP027
pdf Services Teams Actions 02/16/2022 CLP028
pdf Caregiver’s Authorization Affidavit 05/11/2021 CLP029_E
pdf Caregiver’s Authorization Affidavit (Spanish) 05/11/2021 CLP029_S
pdf Request for Verification of Veterans Status for Mental Health and/or Substance Abuse Services 05/11/2021 CLP030
pdf Consent and Authorization to Exchange Confidential Information for Veterans Status 05/11/2021 CLP031
pdf Medication Support Services Plan 05/11/2021 CLP035_E
pdf Medication Support Services Plan (Spanish) 05/11/2021 CLP035_S
pdf Release and Hold Harmless Agreement 05/11/2021 CLP042_E
pdf Release and Hold Harmless Agreement (Spanish) 05/11/2021 CLP042_S
pdf HOST Care Plan 05/11/2021 CLP043
pdf Interdisciplinary Care Team (ICT) Referral Form 05/11/2021 CLP044
pdf DBH 5150-5585 Form 03/02/2022 CLP050
pdf Columbia-Suicide Severity Rating Scale 05/11/2021 CLP051
doc Chart Audit Tool 05/11/2021 QM001
pdf Annual Psychiatric Assessment Review Form 05/11/2021 QM005
pdf Interdisciplinary Care Team (ICT) Referral Form 05/11/2021 QM018
pdf Guidelines for Completing Referral Summary for Referral to Managed Care Plan (MCP) Attachment 05/11/2021 QM018_1
pdf Tier Transition Letter Attachment II 05/11/2021 QM020_E
pdf Tier Transition Letter Attachment II (Spanish) 05/11/2021 QM020_S
docx Your Rights Attachment (NOABD) 05/11/2021 QM024_E
doc Your Rights Attachment (NOABD) (Spanish) 05/11/2021 QM024_S
docx Your Rights Attachment (NAR) 05/11/2021 QM025_E
doc Your Rights Attachment (NAR) (Spanish) 05/11/2021 QM025_S
docx Beneficiary Nondiscrimination Notice 05/11/2021 QM026_E
doc Beneficiary Nondiscrimination Notice (Spanish) 05/11/2021 QM026_S
docx Language Assistance Taglines 05/11/2021 QM027_E
docx Delivery System Notice (NOABD) (Vietnamese)” 07/27/2022 QM029_V
docx Delivery System Notice (NOABD) 07/28/2022 QM029_E
doc Delivery System Notice (NOABD) (Spanish) 07/28/2022 QM029_S
docx Delivery System Notice (NOABD) (Mandarin) 07/27/2022 QM029_M
docx Modification Notice (NOABD) 07/28/2022 QM030_E
docx Modification Notice (NOABD) (Mandarin) 07/27/2022 QM030_M
docx Modification Notice (NOABD) (Vietnamese) 07/27/2022 QM030_V
doc QM030_S “Modification Notice (NOABD) (Spanish) 07/28/2022 QM030_S
pdf Change Order Request Routing Slip 05/11/2021 QM044
pdf State Pre-Audit Chart Review Audit Tool 05/11/2021 QM046
pdf Change of Provider Request Form 06/28/2022 QM047_E
pdf Change of Provider Request Form (Spanish) 06/28/2022 QM047_S
pdf Request for Second Opinion QM048_E Revised! 08/24/2021 QM048_E
pdf Request for Second Opinion (Spanish) QM048_S Revised! 08/24/2021 QM048_S
pdf Mental Health and Alcohol and Drug Services Agency Evaluation 05/11/2021 QM049
pdf Grievance Form 05/11/2021 QM050_E
pdf Grievance Form (Spanish) 05/11/2021 QM050_S
pdf Action Appeal Form 05/11/2021 QM051_E
pdf Quality Assurance Audit At Annual Point 05/11/2021 QM056
pdf Medication Monitoring Questionnaire 05/11/2021 QM057
docx Denial Notice (NOABD) (Vietnamese) 07/27/2022 QM058_V
docx Denial Notice (NOABD) (Mandarin) 07/27/2022 QM058_M
docx Denial Notice (NOABD) 07/28/2022 QM058_E
doc Denial Notice (NOABD) (Spanish) 07/28/2022 QM058_S
docx Termination Notice (NOABD) 05/11/2021 QM059_E
doc Termination Notice (NOABD) (Spanish) 05/11/2021 QM059_S
docx Timely Access Notice (NOABD) 07/28/2022 QM061_E
doc Timely Access Notice (NOABD) (Spanish) 07/28/2022 QM061_S
docx Timely Access Notice (NOABD) (Mandarin) 07/27/2022 QM061_M
docx Timely Access Notice (NOABD) (Vietnamese) 07/27/2022 QM061_V
pdf Medi-Cal Site Certification Checklist 07/19/2022 QM074
pdf Mental Health Plan (MHP) to Medi-Cal Plan (MCP) Referral Form For Non Open Cases 05/11/2021 QM075
docx Financial Liability Notice (NOABD) 07/28/2022 QM078_E
doc Financial Liability Notice (NOABD) (Spanish) 07/28/2022 QM078_S
docx Financial Liability Notice (NOABD) (Mandarin) 07/27/2022 QM078_M
docx Financial Liability Notice (NOABD) (Vietnamese) 07/27/2022 QM078_V
doc Scheduling Template 05/11/2021 CLK003
doc Schedule Change Request 05/11/2021 CLK004
pdf Physician Request Form 05/11/2021 CLK006
pdf myAvatar Program Assignment (Mental Health) 05/11/2021 CLK028
pdf myAvatar Program Assignment (Mental Health)(Spanish) 05/11/2021 CLK028_S
pdf myAvatar CSI Assessment 05/11/2021 CLK029
pdf myAvatar CSI Assessment (Spanish) 05/11/2021 CLK029_S
pdf myAvatar Initial Contact Form (Mental Health 05/11/2021 CLK030
pdf myAvatar Initial Contact Form (Mental Health) (Spanish) 05/11/2021 CLK030_S
pdf Authorization to Release Protected Health Information (PHI) 08/09/2021 COM001_E
pdf Authorization to Release Protected Health Information (PHI) (Spanish) 08/23/2021 COM001_S
pdf Authorization to Release Protected Health Information (PHI) (Vietnamese) 09/15/2021 COM001_V
pdf Code of Conduct and Code of Conduct Acknowledgement 05/11/2021 COM003
pdf Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices 05/11/2021 COM004_E
pdf Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (Spanish) 05/11/2021 COM004_S
pdf Certification Review Hearing – Waiver of Presence 05/11/2021 COM006
pdf Sensitive Chart 05/11/2021 COM007
pdf Outpatient Treatment Reauthorization Request for Adults 05/11/2021 COM010
pdf List of Disclosures of Protected Health Information (PHI) 05/11/2021 COM012
pdf Consent for Outpatient Treatment 05/11/2021 COM013_E
pdf Consent for Outpatient Treatment (Spanish) 05/11/2021 COM013_S
pdf Consent for Outpatient Treatment (Vietnamese) 05/11/2021 COM013_V
pdf Medical Care Authorization for Minor 05/11/2021 COM014_E
pdf Medical Care Authorization for Minor (Spanish) 05/11/2021 COM014_S
pdf Consent for Sound and/or Photographic Recordings 05/11/2021 COM015_E
pdf Consent for Sound and/or Photographic Recordings (Spanish) 05/11/2021 COM015_S
pdf Consent to Record and/or Photograph and Authorization for Use or Disclosure 05/11/2021 COM016_E
pdf Consent to Record and/or Photograph and Authorization for Use or Disclosure (Spanish) 05/11/2021 COM016_S
pdf Advance Health Care Directive 05/11/2021 COM018_E
pdf Advance Health Care Directive (Spanish) 05/11/2021 COM018_S
pdf Delegation of TX Consent 05/11/2021 COM019
pdf Conflict of Interest Disclosure Statement 07/27/2022 COM020
pdf Access to Medical Records Request 05/11/2021 COM021_E
pdf Access to Medical Records Request (Spanish) 05/11/2021 COM021_S
pdf Response to Request to Access Medical Records 05/11/2021 COM022_E
pdf Response to Request to Access Medical Records (Spanish) 05/11/2021 COM022_S
pdf Request to Amend Protected Health Information (PHI) 05/11/2021 COM023_E
pdf Request Request to Amend Protected Health Information (PHI) (Spanish) 05/11/2021 COM023_S
pdf Response to Request to Amend Protected Health Information (PHI) 05/11/2021 COM024_E
pdf Response to Request to Amend Protected Health Information (PHI) (Spanish) 05/11/2021 COM024_S
pdf Internal Tracking of Request to Access Medical Records 05/11/2021 COM025
pdf Release of Information: Patient’s Right of Access to His/Her Own Medical Record 05/11/2021 COM026_E
pdf Release of Information: Patient’s Right of Access to His/Her Own Medical Record (Spanish) 05/11/2021 COM026_S
pdf Oath of Confidentiality 01/14/2022 COM027
pdf Advance Health Care Directive (Brochure) 05/11/2021 COM028_E
pdf Advance Health Care Directive (Brochure) (Spanish) 05/11/2021 COM028_S
pdf Advance Health Care Directive (Brochure) (Vietnamese) 05/11/2021 COM028_V
pdf Privacy and Security Agreement Confidentiality Statement 05/11/2021 COM033
pdf Tracking of PHI Records Delivered Log 05/11/2021 COM034
pdf General Chart Room Log 05/11/2021 COM035
pdf Ineligible Persons Policy Acknowledgement and Attestation 05/11/2021 COM036
pdf Attestation Regarding Completion of Sanction Checks 05/11/2021 COM037
pdf ACA 1557 Grievance Form 05/11/2021 COM038
pdf ACA 1557 Grievance Form (Spanish) 05/11/2021 COM038_S
pdf Electronic Signature Agreement and E-Signature and Provider Signature List 08/03/2022 COM039
pdf DBH & BBS Complaint Notifications to Clients (8-20) 05/11/2021 COM040_E
pdf DBH & BBS Complaint Notifications to Clients (8-20) (Spanish) 05/11/2021 COM040_S
pdf myAvatar Policy/Procedure Acknowledgement Form 05/11/2021 COM041
pdf Patients’ Rights Grievance Form 05/11/2021 PR001_E
pdf Patients’ Rights Grievance Form (Spanish) 05/11/2021 PR001_S
pdf Patients’ Rights Office Grievance Appeal Form 05/11/2021 PR002_E
pdf Patients’ Rights Office Grievance Appeal Form (Spanish) 05/11/2021 PR002_S
pdf Service Authorization Request 03/01/2009 08/12/2021 MH5125
pdf Client Assessment 03/01/2009 08/12/2021 MH5120
pdf Client Assessment Update 03/01/2009 08/12/2021 MH5121
pdf Client Plan 03/01/2009 08/12/2021 MH5122
pdf Action Appeal Form (Spanish) 09/01/2021 QM051_S
pdf Request for Restriction of Confidential Communication 09/16/2021 COM030_E
pdf Request for Restriction of Confidential Communication (Spanish) 09/16/2021 COM030_S
pdf Response to Request for Restriction of Confidential Information 09/16/2021 COM031_E
pdf Response to Request for Restriction of Confidential Information (Spanish) 09/16/2021 COM031_S
pdf Notice to Consumer English MD 10/21/2021 MDS030
pdf Notice to Consumer Spanish MD 10/21/2021 MDS030_S
pdf Notice to Consumer English DO 10/21/2021 MDS031
pdf Notice to Consumer Spanish DO 06/15/2022 MDS031_S
pdf Medical/Behavioral Health Clearance 11/22/2021 SUDRS024
docx Payment Denial Notice 11/22/2021 QM060_E
doc Payment Denial Notice (Spanish) 11/22/2021 QM060_S
docx Authorization Delay Notice 11/22/2021 QM033_E
doc Authorization Delay Notice (Spanish) 11/22/2021 QM033_S
docx Grievance and Appeal Timely Resolution Notice 11/22/2021 QM062_E
doc Grievance and Appeal Timely Resolution Notice (Spanish) 11/22/2021 QM062_S
pdf Unusual Occurrence/Incident Report 04/07/2022 QM053
docx Termination of Provider Notice Template 05/11/2022 CLP045
pdf Mode of Service 04/28/2022 BOP024
pdf Adult (21+) ASAM Triage Level of Care Screening 05/05/2022 SUDRS043
pdf Consent for SUD Care Coordination Services (English) SUDRS035_E
docx Termination of Provider Notice Template_Spanish 05/25/2022 CLP045_S
docx Notice of Grievance Resolution 06/23/2022 QM028_E
doc Notice of Grievance Resolution (Spanish) 06/23/2022 QM028_S
docx Receipt of Grievance Acknowledgement Letter 06/23/2022 QM036_E
docx Receipt of Grievance Acknowledgement Letter (Spanish) 06/23/2022 QM036_S
pdf Grievance Investigation Response Form 06/23/2022 QM076_E
pdf Grievance Investigation Supplemental Response Form 06/23/2022 QM077_E
pdf Fagerstrom Test for Nicotine Dependence 06/22/2022 SUDRS053
Type Name Modified Date Program and Number
pdf Continuity of Care Procedure 07/18/2022 QM6044-2
pdf Network Adequacy Policy 05/17/2021 QM6043
pdf DMC-ODS Requirements for period 2022-2026 08/08/2022 SUDRS0241
pdf Documentation Requirements for all SMHS DMC and DMC-ODS Services 07/28/2022 QM6056
pdf Transition of Care Procedure 07/18/2022 QM6044-3
pdf Clinical Supervision for Pre-Licensed Psychologists 02/16/2022 CLP0842
pdf DBH-IT Data Encryption 02/28/2022 IT5018
pdf DATAR Policy (SUDRS0236) 07/22/2022 SUDRS0236
pdf DATAR Procedure (SUDRS0236-1) 12/15/2021 SUDRS0236-1
pdf Request to Change the DBH Websites Policy (BOP3047) 12/15/2021 BOP3047
pdf Request to Change the DBH Websites Procedure (BOP3047-1) 12/15/2021 BOP3047-1
pdf Physician Consultation Services 09/13/2021 SUDRS0224
pdf Control, Access, Accountability-Meds Supplies Policy 09/13/2021 MDS2008
pdf Scope of Practice Billing Guide
pdf Outpatient Chart Manual
pdf Adult System of Care, Intensive and Aggressive Case Management, and ACSP Coordinated Services 05/13/2021 ADT0101
pdf Case Management Services 05/13/2021 ADT0102
pdf Reporting Dependent Adult/Elder Abuse and Neglect Policy 05/13/2021 ADT0103
pdf Reporting Dependent Adult/Elder Abuse Procedure 05/13/2021 ADT0103-01
pdf Adult System of Care Out-of-County Placement Policy 05/13/2021 ADT0105
pdf Forensic Contraband Policy and Procedure 05/13/2021 ADT0106
pdf DBH Alcohol and Other Drug (AOD) Programs Counselor Certification Policy 05/13/2021 ADS0201
pdf Alcohol and Drug Services Code of Professional Conduct Policy 05/13/2021 ADS0202
pdf Title 22 Fair Hearing Rights Policy 05/13/2021 ADS0205
pdf Charitable Choice Procedure 10/06/2021 SUDRS0209-1
pdf Medication Policy for Clients Seeking Alcohol and Drug Treatment Services 05/13/2021 ADS0210
pdf Alcohol and Drug Services (ADS) Youth Treatment Policy 05/13/2021 ADS0212
pdf Alcohol and Drug Services (ADS) Perinatal Treatment Policy 05/13/2021 ADS0213
pdf Admission Preference and Interim Services Policy 09/13/2021 SUDRS0214
pdf Admission Preference and Interim Services Procedure SUDRS0214-1
pdf Accessibility of Services Policy 08/15/2022 SUDRS0220
pdf Expenditure of the Substance Abuse Prevention and Treatment Block Grant Policy 05/13/2021 ADS0221
pdf Substance Use Disorder Medication Safety and Effectiveness Policy 05/13/2021 SUDRS0223
pdf Substance Use Disorder Service Utilization Policy 05/13/2021 SUDRS0225
pdf Substance Use Disorder and Recovery Services Coordination of Care Policy 05/13/2021 SUDRS0228
pdf Substance Use Disorder and Recovery Services Coordination of Care Procedure 05/13/2021 SUDRS0228-1
pdf California Outcomes Measurement System 05/13/2021 SUDRS0229
pdf California Outcomes Measurement System 04/13/2022 SUDRS0229-1
pdf Post Client Satisfaction Survey Procedure 05/13/2021 SUDRS0230
pdf Substance Use Disorder and Recovery Services Residential Prior Authorization Policy 05/13/2021 SUDRS0231
pdf Case Management Services for Child and Adolescent Clients 05/13/2021 CHD0302
pdf Child Abuse Reporting Policy 05/13/2021 CHD0303
pdf Child Abuse Reporting Procedure 05/13/2021 CHD0303-1
pdf AB 2726 Program Policy 05/13/2021 CHD0307
pdf Financial Interviewer Procedure 05/13/2021 CHD0308
pdf Healthy Families SED Services Policy 05/13/2021 CHD0309
pdf Healthy Families SED Services Procedure 05/13/2021 CHD0309-1
pdf 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
pdf Providing Services to Foster Care Children Placed Out-of-County Procedure 05/13/2021 CHD0311-1
pdf Providing Services to Adoption Assistance Program (AAP) and Kinship Guardianship Assistance Payment (KinGAP) Children Placed Out-of County Procedure 05/13/2021 CHD0311-2
pdf Children’s Fund Immediate Need Voucher Policy 05/13/2021 CHD0315
pdf Children’s Fund Immediate Need Voucher Procedure 05/13/2021 CHD0315-1
pdf Consent for Treatment of Minors Policy 05/13/2021 CHD0316
pdf Consent to Treat a Minor: Procedures for Parents/Legal Guardians 05/13/2021 CHD0316-1
pdf Consent to Treat a Dependent Minor Procedure 05/13/2021 CHD0316-2
pdf Reporting Dependent Adult/Elder Abuse and Neglect Policy 05/13/2021 ADT0103
pdf Reporting Dependent Adult/Elder Abuse Procedure 05/13/2021 ADT0103-1
pdf Outpatient Chart Manual (OCM) 05/13/2021 OCM
pdf Lost and Found Procedure 05/13/2021 CLK0701
pdf Assignment of Meeting Rooms 05/13/2021 CLK0702
pdf Clinic Responsibility for Processing Client Registration, PFI, CDI 05/13/2021 CLK0703
pdf Charge Data Invoice (CDI) Process Procedure 05/13/2021 CLK0704
pdf Scheduling Application Policy 05/13/2021 CLK0705
pdf Correction of Overlapping Service 05/13/2021 CLK0707
pdf Service Deletions and Corrections 05/13/2021 CLK0708
pdf Initial Contact Form 05/13/2021 CLK0711
pdf Procedure for Unscheduled Appointments 05/13/2021 CLK0712
pdf Appointment Scheduling 05/13/2021 CLK0713
pdf No Show Policy 05/13/2021 CLK0714
pdf Field Trips/Conferences 05/13/2021 CLP0802
pdf Treatment of DBH Employees by DBH Facilities 05/13/2021 CLP0804
pdf Acknowledgement of Abuse Reporting Duties Policy 05/13/2021 CLP0805
pdf Clinical Supervision for Licensure AMFT, ACSW, APCC 02/16/2022 CLP0806
pdf Supervision of Occupational Therapists 05/13/2021 CLP0807
pdf Consumer Benefit Assistance Protocol 05/13/2021 CLP0808
pdf Admission Standards for Penal Code Misdemeanor Violations 05/13/2021 CLP0809
pdf Diagnosis of Mental Disorder 05/13/2021 CLP0810
pdf Out-of-County Access for Mental Health Services 05/13/2021 CLP0812
pdf Self Help Group Protocol 05/13/2021 CLP0814
pdf Adjustment of Client Fees 05/13/2021 CLP0815
pdf Waiver of Consumer’s Responsibility to Pay for Medications 05/13/2021 CLP0816
pdf Policies Regarding Authorization and Designation Pursuant to the Lanterman-Petris-Short (LPS) Act 05/13/2021 CLP0818
pdf Duty to Warn and Protect Third Parties in 05/13/2021 CLP0819
pdf Duty to Warn and Protect Third Parties in Response to a Client Threat (Tarasoff) Procedure 05/13/2021 CLP0819-1
pdf Day Treatment Weekly Charting in Staff Meetings 05/13/2021 CLP0821
pdf Psychological Testing 05/13/2021 CLP0822
pdf HIV and AIDS Charting 05/13/2021 CLP0824
pdf Confidentiality When Dealing with Client Support Persons 05/13/2021 CLP0825
pdf Disability Application 05/13/2021 CLP0826
pdf Veterans Services Policy 05/13/2021 CLP0828
pdf Veterans Services Procedure 05/13/2021 CLP0828-1
pdf 5150/5585 Transportation Policy 05/13/2021 CLP0829
pdf 5150/5585 Transportation Procedure 05/13/2021 CLP0829-1
pdf Clients with Physical Medical Conditions Policy 05/13/2021 CLP0830
pdf CWIC Referral Procedure 05/13/2021 CLP0831
pdf Bus Pass Program Policy 05/13/2021 CLP0832
pdf Shelter Bed Services Policy 05/13/2021 CLP0833
pdf Client Substance Use Policy 05/13/2021 CLP0834
pdf Client Substance Use Screening Procedure 05/13/2021 CLP0834-1
pdf Transformational Collaborative Outcomes Management (TCOM) Policy 05/13/2021 CLP0836
pdf Transformational Collaborative Outcomes Management (TCOM) Procedure 05/13/2021 CLP0836-1
pdf Client Notice Regarding Termination of Provider Procedure 04/12/2022 CLP0837
pdf Sending Confidential Information by Facsimile 05/13/2021 COM0901
pdf Subpoena of Medical Records 05/13/2021 COM0902
pdf Advance Health Care Directive Policy 05/13/2021 COM0903
pdf Medical Records Security Policy for Outpatient Services 05/13/2021 COM904
pdf Confidentiality of Protected Health Information (PHI) 05/13/2021 COM0905
pdf Retention of Medical Records Policy 05/13/2021 COM0906
pdf Unauthorized Access of Confidential Medical Records 05/13/2021 COM0907
pdf Medical Records Requiring Special Handling 05/13/2021 COM0908
pdf Medical Records Requiring Special Handling Procedure 05/13/2021 COM0908-1
pdf Electronic Transfer of Client PHI 05/13/2021 COM0909
pdf HIPAA Notice of Privacy Practices (NOPP) Policy 05/13/2021 COM0910
pdf Conflict of Interest Policy 07/27/2022 COM0911
pdf Authorization to Release PHI Policy 08/09/2021 COM0912
pdf Authorization to Release Protected Health Information (PHI) Procedure 01/14/2022 COM0912-1
pdf Trafficking Victims Protection Act of 2000 05/13/2021 COM0913
pdf Code of Conduct 05/13/2021 COM0914
pdf Certification of Billed Services 05/13/2021 COM0915
pdf Compliance Verification, Monitoring and Auditing Policy 05/13/2021 COM0917
pdf Compliance Hotline Policy 05/13/2021 COM0919
pdf Compliance Hotline Procedure 05/13/2021 COM0919-1
pdf DBH Compliance Committee 05/13/2021 COM0920
pdf Sound and Photographic Recordings Policy 05/13/2021 COM0922
pdf Security of Protected Electronic Health Information Policy 05/13/2021 COM0923
pdf Workstation and System Security Policy 05/13/2021 COM0924
pdf Data Integrity Policy 05/13/2021 COM0925
pdf Privacy and Security Incident Sanctions 01/19/2022 COM0926
pdf Fraud, Waste and Abuse Prevention Policy 05/13/2021 COM0927
pdf Access and Amendment of Medical Records Policy 05/13/2021 COM0931
pdf Ineligible Persons Procedure 08/11/2022 COM0933-1
pdf Ineligible Persons Policy 08/11/2022 COM0933
pdf Compliance Plan Policy 05/13/2021 COM0934
pdf Patients’ Rights Policy 05/13/2021 COM0935
pdf Patients’ Rights Inpatient Grievance Process 05/13/2021 COM0935-1
pdf Patients’ Rights Outpatient Grievance Process 05/13/2021 COM0935-2
pdf HIPAA National Provider Identifier (NPI) Policy 05/13/2021 COM0938
pdf HIPAA National Provider Identifier (NPI) Procedure 05/13/2021 COM0938-1
pdf Root Cause Analysis Policy 05/13/2021 COM0939
pdf Right to Request Alternative Means of Communication Protected Health Information Policy 05/13/2021 COM0941
pdf Medicare Provider Certification Policy 05/13/2021 COM0942
pdf Medi-Cal Eligibility Data Systems (MEDS) Policy 05/13/2021 COM0943
pdf MEDS Access and Contacts Procedure 05/13/2021 COM0943-1
pdf Privacy or Security Incident Policy 05/13/2021 COM0944
pdf Client Grievance Policy 05/13/2021 COM0946
pdf MHSA Issue Resolution Process 05/13/2021 COM0947
pdf Transportation of Protected Health Information (PHI) Policy 05/13/2021 COM0948
pdf Transportation of Protected Health Information (PHI) Procedure 05/13/2021 COM0948-1
pdf Non-Discrimination – Section 1557 of the Affordable Care Act Policy 05/13/2021 COM0953
pdf Affordable Care Act (ACA) 1557 Grievance Procedure 05/13/2021 COM953-1
pdf Overpayment Policy 05/13/2021 COM0954
pdf Behavioral Health Services for Clients/Family 05/17/2021 CUL1002
pdf Behavioral Health Services for Clients/Family 05/17/2021 CUL1002-1
pdf Satisfying Clients’ Language Needs 05/17/2021 CUL1004
pdf Consumer Focus Group Policy 05/17/2021 CUL1005
pdf Consumer Focus Group Procedure 05/17/2021 CUL1005-1
pdf Cultural Competency Policy 05/17/2021 CUL1006
pdf Field Testing of Written Materials Policy 05/17/2021 CUL1010
pdf Field Testing of Written Materials Procedure 05/17/2021 CUL1010-1
pdf Providing Translation Services Procedure 05/17/2021 CUL1011
pdf Providing Interpretation Services Procedure 06/13/2022 CUL1012
pdf Providing Written Communications in Threshold/Primary Languages for Consumers/Family Members Policy 05/17/2021 CUL1013
pdf Cultural Competency Training Policy 05/17/2021 CUL1014
pdf Medical Services Staff Organization 05/17/2021 MDS2002
pdf Incorporated Employees – Fiscal Control Procedures 05/17/2021 MDS2003
pdf Guidelines For Psychiatrists Assigned to Outpatient Clinics 05/17/2021 MDS2004
pdf Leave of Absence – Physicians 05/17/2021 MDS2005
pdf Deviation from Standard of Practice of Medicine 05/17/2021 MDS2006
pdf Benzodiazepine Medication Policy 05/17/2021 MDS2007
pdf Control, Access and Accountability of Medications and Medical Supplies Policy 05/17/2021
pdf Control, Access and Accountability of Medications and Medical Supplies Procedure 05/17/2021 MDS2008-1
pdf Controlled Substance Utilization Review and Evaluation System (CURES) Policy 05/17/2021 MDS2010
pdf Controlled Substance Utilization Review and Evaluation System (CURES) Procedure 05/17/2021 MDS2010-1
pdf Medication Appointment – Scheduling 05/17/2021 MDS2011
pdf Sample Injectable Medication Policy 05/17/2021 MDS2012
pdf Handling of Contaminated Waste/Needles and Syringes 05/17/2021 MDS2014
pdf Prescription Policy 05/17/2021 MDS2015
pdf Disability Application 05/17/2021 MDS2016
pdf Consent for Administration of Psychotropic Medication to Minors Policy 05/17/2021 MDS2017
pdf Physician’s Orders (Treatment Plan) 05/17/2021 MDS2018
pdf Laboratory Services/Physical Assessment Policy 05/17/2021 MDS2019
pdf Laboratory Services/Physical Assessment Procedure 05/17/2021 MDS2019-1
pdf Medication Support Groups 05/17/2021 MDS2020
pdf Medical Services Credentialing Procedure 05/17/2021 MDS2021
pdf Patient Assistance Program Policy 05/17/2021 MDS2022
pdf Patient Assistance Program Procedure 05/17/2021 MDS2022-1
pdf Clinical Practice Guideline: Clozapine 05/17/2021 MDS2025
pdf Telehealth Policy 05/17/2021 MDS2027
pdf Telehealth Procedure 05/17/2021 MDS2027-1
pdf Intranasal Naloxone Policy 05/17/2021 MDS2028
pdf Intranasal Naloxone Procedure 05/17/2021 MDS2028-1
pdf Medication Authorization for Dependent Children and Youth Policy 05/17/2021 MDS2029
pdf Urgent and Emergency Conditions Procedure 07/18/2022 MDS2031
pdf Nursing Staff Orientation Protocol 05/17/2021 NUR2101
pdf Control and Organization of the Standard Practice Manual (SPM) Policy 05/17/2021 BOP3001
pdf Requests to Modify Standard Practice Manual Procedure 10/20/2021 BOP3002
pdf Organization of the Department 05/17/2021 BOP3003
pdf Department Vision, Mission and Values Policy 05/17/2021 BOP3004
pdf Communications Procedures 05/17/2021 BOP3005
pdf Incoming Mail – Departmental 05/17/2021 BOP3006
pdf Public Information and Media Release Policy 05/17/2021 BOP3007
pdf Paid Advertising Procedure – General 05/17/2021 BOP3009
pdf Legal Opinion from County Counsel 05/17/2021 BOP3010
pdf Legislative Activities 05/17/2021 BOP3011
pdf Reimbursement for Travel and Related Expenses 05/17/2021 BOP3012
pdf Travel Procedure 05/17/2021 BOP3013
pdf Benefits Team Policy 05/17/2021 BOP3014
pdf Benefits Team Procedure 05/17/2021 BOP3014-1
pdf Vehicle Use Policy 05/17/2021 BOP3015
pdf Vehicle Use Procedure 05/17/2021 BOP3015-1
pdf Maintenance – Plant & Equipment 05/17/2021 BOP3016
pdf Purchasing Procedure 05/17/2021 BOP3017
pdf Use of Supplies and Equipment/Notification of Loss or Damage 05/17/2021 BOP3018
pdf Furniture and Equipment Relocation Procedure 05/17/2021 BOP3019
pdf Surplus Inventory 05/17/2021 BOP3020
pdf Assignment of Pagers to Divisions/Programs and Staff 05/17/2021 BOP3021
pdf Cellular Phones 05/17/2021 BOP3022
pdf Budget Development and Changes 05/17/2021 BOP3023
pdf Petty Cash 05/17/2021 BOP3024
pdf Facility Physical Security and Access Control Policy 05/17/2021 BOP3025
pdf Facility Physical Security and Access Control Procedures 05/17/2021 BOP3025-1
pdf Billing and Collection for Treatment Services Policy 05/17/2021 BOP3027
pdf Gifts and Donations Policy 05/17/2021 BOP3029
pdf Gifts and Donations Procedure 05/17/2021 BOP3029-1
pdf Prepaid Cards Policy 05/17/2021 BOP3030
pdf Prepaid Cards Procedure 05/17/2021 BOP3030-1
pdf Guidelines for Promotional, Educational, and/or Informational Materials 05/17/2021 BOP3031
pdf DBH Review Panel for Promotional, Educations, and/or Informational Materials 05/17/2021 BOP3032
pdf Review of Promotional, Educational and/or Informational Materials Procedure 05/17/2021 BOP3032-1
pdf Assignment, Closure, Merger or Relocation of Clinics Policy 05/17/2021 BOP3033
pdf Closure of DBH Contract Provider Procedure 05/17/2021 BOP3033-1
pdf Assignment of DBH Contract Provider Procedure 05/17/2021 BOP3033-2
pdf Merger of DBH Contract Provider Procedure 05/17/2021 BOP3033-3
pdf Relocation of Clinic Procedure 05/17/2021 BOP3033-4
pdf Employee Recognition Policy 05/17/2021 BOP3037
pdf Telecommunication Devices Policy 05/17/2021 BOP3040
pdf Telecommunication Devices Procedures 05/17/2021 BOP3040-1
pdf Medi-Cal Claim Certification of Authenticity Policy 05/17/2021 BOP3042
pdf Web Blast Policy 06/22/2022 BOP3045
pdf Web Blast Procedure 06/22/2022 BOP3045-1
pdf Outreach Events Policy 05/17/2021 BOP3046
pdf Outreach Events Procedure 05/17/2021 BOP3046-1
pdf Approval for Filling Vacancies 05/17/2021 HR4002
pdf Advertising Procedures – Employment 05/17/2021 HR4003
pdf New Hire Policy 05/17/2021 HR4004
pdf Employee Separation Procedure 05/17/2021 HR4006
pdf Work Schedules Policy 05/17/2021 HR4007
pdf Intra-Department Reassignment Policy (Supersedes-Employee Reassignment Requests) 05/17/2021 HR4008
pdf Intra-Department Reassignment Procedure 05/17/2021 HR4008-1
pdf Employment Physicals 05/17/2021 HR4009
pdf Clinical Therapists Reassignment Request 05/17/2021 HR4010
pdf Waiver for Pre-Licensed/Out-of-State Licensed Ready Psychologists 01/25/2022 HR4011
pdf Registration and Licensure Requirements for Clinical Therapists 05/17/2021 HR4012
pdf Volunteer Policy 05/17/2021 HR4013
pdf Volunteer Request and Registration Procedure 05/17/2021 HR4013-1
pdf Non-Discrimination / Equal Employment Opportunity 05/17/2021 HR4015
pdf Dress and Grooming Policy 05/17/2021 HR4016
pdf Disability Discrimination Complaints 05/17/2021 HR4017
pdf Personnel Records 05/17/2021 HR4018
pdf Telephone Calls – Personal 05/17/2021 HR4019
pdf Smoking and Tobacco Use Policy 05/17/2021 HR4020
pdf Time and Attendance Form – How to Complete 05/17/2021 HR4021
pdf Time and Attendance Correction 05/17/2021 HR4021-1
pdf Vacation Leave – Request 05/17/2021 HR4023
pdf Overtime Policy 05/17/2021 HR4025
pdf Position Transfer Reassignment & Borrowing Policy 05/17/2021 HR4026
pdf Position Transfer Reassignment & Borrowing Procedure 05/17/2021 HR4026-1
pdf Tuberculosis Screening Policy 05/17/2021 HR4030
pdf Tuberculosis Screening Procedure 05/17/2021 HR4030-1
pdf Procedure for Purchasing Computer Equipment 05/17/2021 IT5001
pdf Request for Information Technology Support Procedure 05/17/2021 IT5002
pdf Internet Access policy 05/17/2021 IT5003
pdf Computer and Network Appropriate Use Policy 05/17/2021 IT5004
pdf Electronic Mail Use Policy 05/17/2021 IT5005
pdf Risk Assessment Policy 05/17/2021 IT5007
pdf Device and Media Controls Policy 05/17/2021 IT5008
pdf User- I.D. and Password Policy 05/17/2021 IT5009
Superseded by myAvatar User Account Creation and Reinstatement Procedure 12/15/2021 IT5012-5
pdf Medi-Cal Site Certification Policy 07/22/2022 QM6002
pdf Medi-Cal Site Certification Procedure 07/22/2022 QM6002-1
pdf QShort-Doyle and Short-Doyle/Medi-Cal Clinic Change of Ownership or Location 05/17/2021 QM6003
pdf Research and Evaluation Functions 05/17/2021 QM6004
pdf Research Review Committee 05/17/2021 QM6005
pdf Requesting an Initial Choice of Provider or Change of Provider Procedure 07/19/2022 QM6006-1
pdf Requesting an Initial Choice of Provider or Change of Provider Policy 07/19/2022 QM6006
pdf Credentialing Policy 05/17/2021 QM6008
pdf Credentialing Procedure 05/17/2021 QM6008-1
pdf Quality Management Committee Membership/Participation 05/17/2021 QM6009
pdf Written Informing Materials Policy 05/17/2021 QM6012
pdf Post State Audit Procedures 05/17/2021 QM6014
pdf Pre State Chart Audit Responsibilities & Procedures 05/17/2021 QM6015
pdf Procedure for Submission of Chart Documentation and Charge Data Invoices (CDIs) 05/17/2021 QM6016
pdf Billing Guidelines for Quality Assurance Activities 05/17/2021 QM6019
pdf Outpatient Chart Audit – Site Review Policy 05/17/2021 QM6020
pdf Investigating and Reporting Death of a DBH Client 05/17/2021 QM6021
pdf Quality of Care Referral Policy 05/17/2021 QM6022
pdf Quality of Care Referral Procedure 05/17/2021 QM6022-1
pdf SAMHSA Block Grant-Annual Program Review Procedure 05/17/2021 QM6024
pdf Fee-For Service Credentialing Procedure 05/17/2021 QM6026
pdf DBH Provider Directories Policy 05/17/2021 QM6027
pdf Grievance and Appeal Policy 05/17/2021 QM6029
pdf Grievance Procedure 05/17/2021 QM6029-1
pdf State Hearing Procedure 05/17/2021 QM6029-2
pdf Standard and Expedited Resolution of Appeals Procedure 05/17/2021 QM6029-3
pdf NOABD Procedure 05/17/2021 QM6029-4
pdf Research Policy 05/17/2021 QM6032
pdf Service Delivery Definition Policy 05/17/2021 QM6036
pdf Consistency in Inpatient and Outpatient Utilization Review and Authorization Practices Policy 07/19/2022 QM6038
pdf Consistency in Inpatient Utilization Review and Authorization Practices Procedure 07/19/2022 QM6038-1
pdf Consistency in Outpatient Utilization Review and Authorization Practices Procedure 07/19/2022 QM6038-2
pdf MHP Point of Authorization Plan for Inpatient Psychiatric Hospitalization Protocol 05/17/2021 QM6039
pdf Tier Transition Protocol 05/17/2021 QM6040
pdf Timely Access Procedure 08/18/2022 QM6041-1
pdf Timely Access Policy 07/19/2022 QM6041
pdf Network Adequacy Procedure 05/17/2021 QM6043-1
pdf Out of Network Policy 07/18/2022 QM6044
pdf Out of Network Access Procedure 07/18/2022 QM6044-1
pdf 24/7 Access Line Requirements Policy 07/20/2022 QM6045
pdf 24/7 Access Line Requirements Procedure 07/20/2022 QM6045-1
pdf Service Availability Policy 07/19/2022 QM6046
pdf Selection and Retention of Network Provider Policy 05/17/2021 QM6048
pdf Department Liability for Employees and Volunteers’ Action Outside Work 05/18/2021 SFT7002
pdf Bomb Threat Procedure 05/18/2021 SFT7005
pdf Earthquake Procedures 05/18/2021 SFT7006
pdf Disaster and Mass Casualty Policy 05/18/2021 SFT7007
pdf Air Pollution Emergency Episode Plan 05/18/2021 SFT7008
pdf Assaultive Behavior Plan (ABP) Policy 05/18/2021 SFT7009
pdf Assaultive Behavior Plan (ABP) Procedure 05/18/2021 SFT7009-1
pdf Possession of a Weapon Policy 05/18/2021 SFT7010
pdf Possession of a Weapon Procedure 05/18/2021 SFT7010-1
pdf Safety and Emergency Coordination Policy 05/18/2021 SFT7011
pdf Electrical Safety Policy: Personal Appliances 05/18/2021 SFT7012
pdf Safety in the Field Procedure 05/18/2021 SFT7013
pdf Threats Against Federal or State Officials Policy 05/18/2021 SFT7014
pdf Threats and Assault on DBH Staff Policy 05/18/2021 SFT7015
pdf Threats and Assault on DBH Staff Procedure 05/18/2021 SFT7015-1
pdf Special Incident Reporting Procedure – Client Related 05/18/2021 SFT7016
pdf How to Report an Incident 05/18/2021 SFT7017
pdf Hazard Reporting Policy 05/18/2021 SFT7018
pdf Vehicle Accidents Reporting Procedure 05/18/2021 SFT7019
pdf Occupational Injury or Illness Reporting Procedure 05/18/2021 SFT7020
pdf Employee General Safety Policy 05/18/2021 SFT7021
pdf Emergency Action Plan (EAP) Policy 05/18/2021 SFT7022
pdf Disaster Equipment Security Policy 05/18/2021 SFT7023
pdf Kiln Policy 05/18/2021 SFT7024
pdf Local Community Crisis Incident Response Procedure 05/18/2021 SFT7028
pdf Office Ergonomics Intervention Program Policy 05/18/2021 SFT7029
pdf Interagency Communication of Unusual Events Procedure 05/18/2021 SFT7032
pdf Education and Training Policy 10/19/2021 TRA8001
pdf Executive Training Committee Policy 05/18/2021 TRA8003
pdf Training Payment Procedure 05/18/2021 TRA8004
pdf Training Attendance Policy 05/18/2021 TRA8005
pdf Training Tuition Reimbursement Policy 05/18/2021 TRA8006
pdf Training Tuition Reimbursement Procedure 05/18/2021 TRA8006-1
pdf Training Coordination Policy 05/18/2021 TRA8008
pdf Training Coordination Procedure 09/29/2021 TRA8008-1
pdf License Exam Prep Program Policy 05/18/2021 TRA8010
pdf Bilingual Certification Policy 08/24/2021 HR4031
pdf Request for Second Opinion QM6053 New! 08/24/2021 QM6053
pdf Request for Second Opinion Procedure QM6053-1 New! 08/24/2021 QM6053-1
pdf SUDRS Master Provider File Procedure 09/07/2021 SUDRS0238
pdf Substance Use Disorder and Recovery Services Policy 09/07/2021 SUDRS0207
pdf Substance Use Disorder and Recovery Services Procedure 09/07/2021 SUDRS0207-1
pdf Naloxone Intranasal Distribution Policy 09/07/2021 MDS2032
pdf Naloxone Intranasal Distribution Procedure 09/07/2021 MDS2032-1
pdf Advance Health Care Directive 09/23/2021 COM005
pdf Remote Access Policy 09/28/2021 IT5006
pdf Client Tuberculosis (TB) Testing and Services Policy 11/03/2021 SUDRS0219
pdf Client Tuberculosis (TB) Testing and Services Procedure 11/03/2021 SUDRS0219-1
pdf myAvatar Electronic Health Records Policy 12/15/2021 IT5012
pdf myAvatar User Account Request Procedure 12/15/2021 IT5012-1
pdf myAvatar User Account Creation and Reinstatement Procedure 12/15/2021 IT5012-2
pdf myAvatar User Account Modification Procedure 12/15/2021 IT5012-3
pdf myAvatar User Account Deactivation Procedure 12/15/2021 IT5012-4
pdf Criteria for Beneficiary Access to SMHS Medical Necessity and other Requirements 06/14/2022 QM6054
pdf Medication Support Only Case Policy 06/22/2022 MDS2009
pdf No Wrong Door for Mental Health Services Policy 07/01/2022 QM6055
pdf Test Call Policy 07/20/2022 QM6057
Type Name Modified Date Notice Number
pdf Evaluation Code Changes 01/21/2021 IN 20-09
pdf Revised Mental Health Co-Staffing Chart Documentation a 07/01/2020 IN 20-07
pdf Personal Protective Equipment (PPE) for DBH Programs 06/01/2020 IN 20-06
pdf Quality Management Chart Documentation Guidance due to 05/01/2020 IN 20-05
pdf A1 DUI Guidance due to COVID-19 05/01/2020 IN 20-05
pdf A2 NTP Guidance due to COVID-19 05/01/2020 IN 20-05
pdf Administration Guidance due to COVID-19 05/01/2020 IN 20-05
pdf New Classification of Other Qualified Providers 02/01/2020 IN 20-02
pdf Suicide Prevention Training Requirement 01/01/2020 IN 20-01
pdf Coronavirus (COVID-19) Information for DBH Workforce 08/11/2021 IN 20-04
pdf Mental Health Consumer Perception Survey – Spring 2019 08/12/2021 IN 19-01
pdf DMC-ODS UCLA Treatment Perception Survey-October 2019 08/12/2021 IN 19-02
pdf Notice of Changes to EPSDT Data Collection Requirements 08/12/2021 IN 19-04
pdf Approved Abbreviations New! 08/12/2021 IN 19-05
pdf Editing Notice of Adverse Benefit Determination (NOABD) 08/12/2021 IN 19-06
pdf Mental Health Consumer Perception Survey-Fall 2019 New! 08/12/2021 IN 19-07
pdf Consolidation of Electronic Signature (E-Signature) 08/12/2021 IN 19-08
pdf New Medicare Beneficiary Identifier (MBI) New! 08/12/2021 IN 19-09
pdf Network Adequacy Requirements and Deadline (03/01/2018) 08/12/2021 IN 18-01
pdf Updated Authorization to Release Protected Health Info 08/12/2021 IN 18-02
pdf Child and Adolescent Needs and Strengths (CANS)(PSC-35) 08/12/2021 IN 18-03
pdf UCLA Treatment Perceptions Survey Information (9/20/18) 08/12/2021 IN 18-04
pdf Mental Health Consumer Perception Survey – Fall 2018 08/12/2021 IN 18-05
pdf Office Configuration Safety Standards (12/18/2018) New! 08/12/2021 IN 18-06
pdf Standing Order Requirement for Administering NARCAN 08/12/2021 IN 18-08
pdf Disaster Response Requirements (02/01/2017) New! 08/12/2021 IN 17-01
pdf Revised Child/Adolescent Psychiatric Evaluation CLP014 08/12/2021 IN 17-02
pdf SIMON Update (03/01/2017) New! 08/12/2021 IN 17-03
pdf Regulations Regarding Welfare and Institutions Code WIC 08/12/2021 IN 17-05
pdf CLP015-1 Child/Adolescent Assessment-CANS-SB 05/02/2017 08/12/2021 IN 17-07
pdf Implementation of the Diagnostic and Statistical Manual 08/12/2021 IN 17-09
pdf Medicaid Managed Care Final Rule Implementation 08/12/2021 IN 17-10
pdf Confidentiality Statement Requirement for Safeguarding 08/12/2021 IN 17-11
pdf Oath of Confidentiality (Contractors) 01/14/2022 IN 17-11 Appendix A
pdf Implementation of Title Change of Marriage and Family 08/12/2021 IN 17-12
pdf Psychiatric Mental Health Nurse Practitioners 08/12/2021 IN 17-14
pdf New Mental Health Procedure Codes (10/13/2016) 08/12/2021 IN 16-03
pdf Outpatient Chart Manual and Scope of Practice Guide 08/12/2021 IN 16-02
pdf Revised Medicare Certification Requirement (01/29/2016) 08/12/2021 IN 11-04
pdf Electronic Mail (e-mail) Encryption (11/19/2015) 08/12/2021 IN 15-04
pdf Contact by Outside State or Federal Agencies 08/12/2021 IN 14-12
pdf Breining Institute Accreditation Termination 08/12/2021 IN 14-11
pdf Guidelines for Day Treatment Intensive 08/12/2021 IN 14-10
pdf Updates to the Scope of Practice and Billing Guide 08/12/2021 IN 14-06
pdf Updated DBH Billing Forms and Reference Materials 08/12/2021 IN 14-09
pdf Medi-Cal Expansion-Determining Tier III Service 08/12/2021 IN 14-05
pdf ICD-10 Implementation Delayed (04/03/2014) 08/12/2021 IN 14-08
pdf Medicare Updates Regarding ICD-10 (02/20/2014) 08/12/2021 IN 14-01
pdf Medi-Cal Expansion (02/11/2014) 08/12/2021 IN 14-03
pdf Updates to the Scope of Practice and Billing Guide 08/12/2021 IN 14-02
pdf Updates to the Lanterman-Petris-Short (LPS) Act 08/12/2021 IN 13-13
pdf Diagnostic and Statistical Manual of Mental Disorder 08/12/2021 IN 13-15
pdf Discontinuance of Procedure Code 365 (11/05/2015) 08/12/2021 IN 15-02
pdf Non-use of Blood Glucometers (06/02/2015) 08/12/2021 IN 15-01 Non-use of Blood Glucometers (06/02/2015)
pdf Marriage and Family Therapist Intern Experience 08/12/2021 IN 13-10
pdf Board of Behavioral Sciences (BBS) Amendments 08/12/2021 IN 13-09
pdf Care Necessity Form – Revision (09/13/2013) 08/12/2021 IN 13-08
pdf Medicare Administrative Contract Transition 07/15/2013 08/12/2021 IN 13-07
pdf Mental Health Plan (MHP) Contract Clarifications 08/12/2021 IN 13-05
pdf Client Index Number (CIN) Policy Enforcement 07/02/2013 08/12/2021 IN 13-06
pdf DBH Library Protocol (05/08/2013) 08/12/2021 IN 13-03
pdf Accreditation of Certifying Organizations (04/30/2013) 08/12/2021 IN 13-04
pdf Disclosure of Ownership (03/18/2013) 08/12/2021 IN 13-01 Disclosure of Ownership (03/18/2013)
pdf Changes in Charge Data Invoice (CDI) Codes (12/27/2012) 08/12/2021 IN 12-05
pdf Outpatient Chart Manual/Initial Contact Form 12/20/2012 08/12/2021 IN 12-06
pdf License Denied or Suspended for Failure to Pay Taxes 08/12/2021 IN 12-02
pdf Clinical Re-Assessment (07/24/2012) 08/12/2021 IN 12-03
pdf Requirements for Lactation Accommodations (01/06/2012) 08/12/2021 IN 12-01
pdf Board Referral of Matters to County Staff (10/26/2011) 08/12/2021 IN 11-17
pdf Authorization of Release of Protected Health Info 08/12/2021 IN 11-13
pdf Sharing of Protected Health Information relating to MH 08/12/2021 IN 11-11
pdf Medi-Cal Claims Processing Requirements When Other 08/12/2021 IN 11-10
pdf Scope of Practice and Billing Guide (05/17/2011) 08/12/2021 IN 11-07
pdf Updates to Universal Chart Data Invoice (CDI) Codes 08/12/2021 IN 11-06
pdf Outpatient Chart Manual (OCM) Revision (05/09/2011) 08/12/2021 IN 11-08
pdf Assembly Bill (AB) 583 (01/18/2011) 08/12/2021 IN 11-02
pdf Medi-Cal Eligibility System (MEDS) (01/18/2011) 08/12/2021 IN 11-01
pdf Generic Medication (11/19/2010) 08/12/2021 IN 10-15
pdf Sanctions for Certification of Excluded, Suspended 08/12/2021 IN 10-14
pdf JAG-OTP Funds (08/11/2010) 08/12/2021 IN 10-10
pdf AMA Notice To Consumer 10/07/2021 IN 10-09
pdf Adhering to Educational Regulations (05/26/2010) 08/12/2021 IN 10-08
pdf Providing Written Communication to Consumers/Family 08/12/2021 IN 10-07
pdf Medicare: Forms Update & Review Process (03/01/2010) 08/12/2021 IN 10-05
pdf Certification of Alcohol and Other Drug (AOD) Counselor 08/12/2021 IN 10-04
pdf Simon Update for Short Doyle/Medi-Cal Phase II 08/12/2021 IN 10-03
pdf Approval of Promotional, Educational and/or Information 08/12/2021 IN 09-11
pdf Outpatient Chart Manual (04/08/2009) 08/12/2021 IN 09-10
pdf Referral of Clients from Contract Agencies 08/12/2021 IN 09-06
pdf Health Family SED Services Policy/Procedures 02/11/2009 08/12/2021 IN 09-03
pdf Practice and Billing Guide (02/01/2009) 08/12/2021 IN 09-02
pdf Outpatient Chart Manual (OCM) Changes (01/26/2009) 08/12/2021 IN 09-01
pdf Inpatient Claims for Medi-Cal Recipients with other 08/12/2021 IN 08-07
pdf Deficit Reduction Act Compliance (11/24/2008) 08/12/2021 IN 08-04
pdf Incentive Cards Procedure and Controls (12/10/2007) 08/12/2021 IN 07-05
pdf CDPH Orders for Behavioral Health Facilities & Workers 09/10/2021 IN 21-03
pdf Flexibilities for Medicare Telehealth Services 12/01/2021 IN 21-02
pdf Chart Entry to Address Provider Professional Credentials 12/02/2021 IN 21-04
Type Name Modified Date Program and Number Actions
pdf Mode and Service Function Information 12/20/2021 Fiscal
pdf PEI Modes of Service 12/20/2021 Fiscal