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 Tuberculosis Screening Questionnaire 05/02/2024 SUDRS059 Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (Spanish) COM004_S Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (VIE) COM004_V Change of Provider Request Form – 18pt. font (Spanish) 06/28/2022 QM047_S Request for Translation and Interpretation Services 06/12/2024 CUL012 Translation Service Request Form 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) 11/15/2023 QM026_M Beneficiary Nondiscrimination Notice (Vietnamese) 11/15/2023 QM026_V Your Rights Attachment (NOABD) (Mandarin) 11/15/2023 QM024_M Your Rights Attachment (NOABD) (Vietnamese) 11/15/2023 QM024_V Change of Provider Request Form – 18pt. font (English) 06/28/2022 QM047_E Code of Professional Conduct for Drug and Alcohol Staff 05/05/2022 SUDRS001 Adolescent (Age 12-17) and Young Adult ASAM TRIAGE LEVEL OF CARE SCREENING – Instructions 05/10/2022 SUDRS044 Consent for SUD Care Coordination Services (Spanish) SUDRS035_S Care Coordination Needs Determination Screening Tool (English) SUDRS036_E SUD Care Coordination Needs Determination Screening Tool (Spanish) SUDRS036_S SUD Care Coordination Plan (English) 06/01/2023 SUDRS037_E SUD Care Coordination Plan (Vietnamese) 06/01/2023 SUDRS037_V SUD Care Coordination Plan (Mandarin) 06/01/2023 SUDRS037_M SUD Care Coordination Plan (Spanish) 06/01/2023 SUDRS037_S Care Coordination Discharge Summary (English) SUDRS038_E Care Coordination Discharge Summary (Spanish) SUDRS038_S CalOMS Administrative Discharge SUDRS045 CalOMS Admission 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 09/05/2024 Staff Master Worksheet Update Staff Master Worksheet Adult Screening Tool for Medi-Cal Mental Health Services 09/26/2024 DHCS 8765 A Youth Screening Tool for Medi-Cal Mental Health Services 09/26/2024 DHCS 8765 C Transition of Care Tool for Medi-Cal Mental Health Services 09/26/2024 DHCS 8765 B Mental Health Professional Licensing Waiver Request 08/30/2022 DHCS 1739 Title 22 Fair Hearing Rights 01/31/2023 SUDRS002_E Title 22 Fair Hearing Rights (Spanish) 01/31/2023 SUDRS002_S Title 22 Fair Hearing Rights (Mandarin) 01/31/2023 SUDRS002_M Title 22 Fair Hearing Rights (Vietnamese) 01/31/2023 SUDRS002_V Notice of Personal Rights / Civil Rights 11/27/2023 SUDRS003_E Notice of Personal Rights / Civil Rights (Spanish) 11/27/2023 SUDRS003_S Notice of Personal Rights / Civil Rights (Mandarin) 11/27/2023 SUDRS003_M Notice of Personal Rights / Civil Rights (Vietnamese) 11/27/2023 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 07/29/2024 SUDRS028 Handbook Summary and Acknowledgement Form (English) 05/10/2021 SUDRS029_E Handbook Summary and Acknowledgement Form (Spanish) 05/10/2021 SUDRS029_S SUDRS-MH Grievance and Appeals Process Brochure (English) 05/10/2021 SUDRS030_E SUDRS-MH Grievance and Appeals Process Brochure (Spanish) 05/10/2021 SUDRS030_S SUDRS-MH Grievance and Appeals Process Brochure- 18pt. font (Spanish) 05/10/2021 SUDRS030_S SUDRS-MH Grievance and Appeals Process Brochure-18pt. font (English) SUDRS030_E Adolescent (Age 12-17) and Young Adult ASAM Level of Care Screening 09/04/2024 SUDRS031 Adolescent (age 12-17) And Young Adult (age 18-20) Dmc-ods Transition New! 05/10/2021 SUDRS033 SUD Referral 11/15/2023 SUDRS034 Recovery Services Plan 05/10/2021 SUDRS039 DBH-SUDRS CalOMS Admission-Outpatient 08/02/2024 SUDRS051 ASAM Level of Care 03/07/2024 SUDRS042 DBH-SUDRS CalOMS Annual Update 08/02/2024 SUDRS052 Therapeutic Behavioral Services Service Assessment 05/11/2021 CHD012 Therapeutic Behavioral Services Risk Assessment 05/11/2021 CHD013 Therapeutic Behavioral Services Referral Form 05/11/2021 CHD014 Children’s Interagency Authorization To Exchange Confidential Health Information (phi) 05/11/2021 CHD025_E Children’s Interagency Authorization To Exchange Confidential Health Information (phi) (spanish) 05/11/2021 CHD025_S Episode Opening And Closing Codes 05/11/2021 CLP_CODES Possession of a Weapon Notice for Clinics 09/16/2024 SFT009 Possession of a Weapon Notice for Clinics_Vietnamese 09/16/2024 SFT009_Vietnamese Possession of a Weapon Notice for Clinics_Mandarin 09/16/2024 SFT009_Mandarin Possession of a Weapon Posted Notice for Clinics_Spanish 09/16/2024 SFT009_Spanish 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) 09/05/2024 CLP013 (Fill) Adult Psychiatric Evaluation (Printable) 09/05/2024 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 09/24/2024 CLP028 Caregiver’s Authorization Affidavit 05/11/2021 CLP029_E Caregiver’s Authorization Affidavit (spanish) 05/11/2021 CLP029_S Request For Verification Of Veterans Status For Mental Health And/or Substance Abuse Services 05/11/2021 CLP030 Consent And Authorization To Exchange Confidential Information For Veterans Status 05/11/2021 CLP031 Medication Support Services Plan 05/11/2021 CLP035_E Medication Support Services Plan (spanish) 05/11/2021 CLP035_S Release And Hold Harmless Agreement 05/11/2021 CLP042_E Release And Hold Harmless Agreement (spanish) 05/11/2021 CLP042_S Host Care Plan 05/11/2021 CLP043 Interdisciplinary Care Team (ict) Referral Form 05/11/2021 CLP044 DBH 5150/5585 Assessment/Evaluation/Cris Form (DHCS 1801) 02/28/2024 CLP050 Columbia-suicide Severity Rating Scale 05/11/2021 CLP051 Chart Audit Tool 05/11/2021 QM001 Annual Psychiatric Assessment Review Form 05/11/2021 QM005 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) (English) 11/15/2023 QM024_E Your Rights Attachment (NOABD) (Spanish) 11/15/2023 QM024_S Your Rights Attachment (nar) 05/11/2021 QM025_E Your Rights Attachment (nar) (spanish) 05/11/2021 QM025_S Beneficiary Nondiscrimination Notice (English) 11/15/2023 QM026_E Beneficiary Nondiscrimination Notice (Spanish) 11/15/2023 QM026_S Language Assistance Taglines 11/15/2023 QM027_E Delivery System Notice (NOABD) (Vietnamese)” 11/15/2023 QM029_V Delivery System Notice (NOABD) 11/15/2023 QM029_E Delivery System Notice (NOABD) (Spanish) 11/15/2023 QM029_S Delivery System Notice (NOABD) (Mandarin) 11/15/2023 QM029_M Modification Notice (NOABD) 11/15/2023 QM030_E Modification Notice (NOABD) (Mandarin) 11/15/2023 QM030_M Modification Notice (NOABD) (Vietnamese) 11/15/2023 QM030_V QM030_S “Modification Notice (NOABD) (Spanish) 11/15/2023 QM030_S Change Order Request Routing Slip 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) 11/15/2023 QM058_V Denial Notice (NOABD) (Mandarin) 11/15/2023 QM058_M Denial Notice (NOABD) 11/15/2023 QM058_E Denial Notice (NOABD) (Spanish) 11/15/2023 QM058_S Termination Notice (NOABD) (English) 11/15/2023 QM059_E Termination Notice (noabd) (spanish) 05/11/2021 QM059_S Timely Access Notice (NOABD) 11/15/2023 QM061_E Timely Access Notice (NOABD) (Spanish) 11/15/2023 QM061_S Timely Access Notice (NOABD) (Mandarin) 11/15/2023 QM061_M Timely Access Notice (NOABD) (Vietnamese) 11/15/2023 QM061_V Medi-Cal Site Certification Checklist 07/19/2022 QM074 Mental Health Plan (mhp) To Medi-cal Plan (mcp) Referral Form For Non Open Cases 05/11/2021 QM075 Financial Liability Notice (NOABD) 11/15/2023 QM078_E Financial Liability Notice (NOABD) (Spanish) 07/28/2022 QM078_S Financial Liability Notice (NOABD) (Mandarin) 07/27/2022 QM078_M Financial Liability Notice (NOABD) (Vietnamese) 07/27/2022 QM078_V Scheduling Template 05/11/2021 CLK003 Schedule Change Request 05/11/2021 CLK004 Physician Request Form 05/11/2021 CLK006 Myavatar Program Assignment (mental Health) 05/11/2021 CLK028 Myavatar Program Assignment (mental Health)(spanish) 05/11/2021 CLK028_S Myavatar 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 11/15/2023 COM003 Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices 10/19/2022 COM004_E Certification Review Hearing – Waiver Of Presence 05/11/2021 COM006 Sensitive Chart 05/11/2021 COM007 Outpatient Treatment Reauthorization Request For Adults 05/11/2021 COM010 List Of Disclosures Of Protected Health Information (phi) 05/11/2021 COM012 Consent For Outpatient Treatment 05/11/2021 COM013_Et Consent For Outpatient Treatment (spanish) 05/11/2021 COM013_S Consent For Outpatient Treatment (vietnamese) 05/11/2021 COM013_V Medical Care Authorization For Minor 05/11/2021 COM014_E Medical Care Authorization For Minor (spanish) 05/11/2021 COM014_S Consent For Sound And/or Photographic Recordings 05/11/2021 COM015_E Consent For Sound And/or Photographic Recordings (spanish) 05/11/2021 COM015_S Consent To Record And/or Photograph And Authorization For Use Or Disclosure 05/11/2021 COM016_E Consent To Record And/or Photograph And Authorization For Use Or Disclosure (spanish) 05/11/2021 COM016_S Advance Health Care Directive 05/11/2021 COM018_E Advance Health Care Directive (spanish) 05/11/2021 COM018_S Delegation Of Tx Consent 05/11/2021 COM019 Conflict of Interest Disclosure Statement 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 Request To Amend Protected Health Information (phi) 05/11/2021 COM023_E Request Request To Amend Protected Health Information (phi) (spanish) 05/11/2021 COM023_S Response To Request To Amend Protected Health Information (phi) 05/11/2021 COM024_E Response To Request To Amend Protected Health Information (phi) (spanish) 05/11/2021 COM024_S Release Of Information: Patient’s Right Of Access To His/her Own Medical Record 05/11/2021 COM026_E Release Of Information: Patient’s Right Of Access To His/her Own Medical Record (spanish) 05/11/2021 COM026_S Oath of Confidentiality 01/14/2022 COM027 Advance Health Care Directive (brochure) 05/11/2021 COM028_E Advance Health Care Directive (brochure) (spanish) 05/11/2021 COM028_S Advance Health Care Directive (brochure) (vietnamese) 05/11/2021 COM028_V Privacy And Security Agreement Confidentiality Statement 05/11/2021 COM033 Tracking Of Phi Records Delivered Log 05/11/2021 COM034 General Chart Room Log 05/11/2021 COM035 Ineligible Persons Policy Acknowledgement And Attestation 05/11/2021 COM036 Attestation Regarding Completion Of Sanction Checks 05/11/2021 COM037 Aca 1557 Grievance Form 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 05/01/2024 SUDRS024 Payment Denial Notice (NOABD) 11/15/2023 QM060_E Payment Denial Notice (Spanish) 11/22/2021 QM060_S Authorization Delay Notice (NOABD) 11/15/2023 QM033_E Authorization Delay Notice (Spanish) 11/15/2023 QM033_S Grievance and Appeal Timely Resolution Notice (NOABD) 11/15/2023 QM062_E Grievance and Appeal Timely Resolution Notice (Spanish) 11/22/2021 QM062_S Unusual Occurrence/Incident Report 04/07/2022 QM053 Termination of Provider Notice Template – Mandarin 05/22/2024 CLP045 Termination of Provider Notice Template – Vietnamese 05/22/2024 CLP045 Termination of Provider Notice Template 05/11/2022 CLP045 Mode of Service 04/28/2022 BOP024 Adult (21+) ASAM Triage Level of Care Screening 05/05/2022 SUDRS043 Consent for SUD Care Coordination Services (English) SUDRS035_E Termination of Provider Notice Template_Spanish 05/25/2022 CLP045_S Notice of Grievance Resolution 06/23/2022 QM028_E Notice of Grievance Resolution (Spanish) 06/23/2022 QM028_S Receipt of Grievance Acknowledgement Letter 06/23/2022 QM036_E Receipt of Grievance Acknowledgement Letter (Spanish) 06/23/2022 QM036_S Grievance Investigation Response Form 06/23/2022 QM076_E Grievance Investigation Supplemental Response Form 06/23/2022 QM077_E Fagerstrom Test for Nicotine Dependence 06/22/2022 SUDRS053 Pre-Licensed/Out-of-State Licensed Psychologists Statement of Awareness for Continued Employment 08/30/2022 HR006 Non-Medication Resource Log and Instructions 07/19/2023 MDS032 Contingency Management: Recovery Incentives Program Consent Form 08/06/2024 SUDRS054 Contingency Management: Recovery Incentives Program Consent Form (Spanish) 01/05/2024 SUDRS054 Authorization Delay Notice (Mandarin) 11/15/2023 QM033_M Authorization Delay Notice (Vietnamese) QM033_V SUDRS058 Discharge Summary 01/05/2024 SUDRS058 SUDRS Discharge Plan_E 01/05/2024 SUDRS057 SUDRS057_V SUDRS Discharge Plan (Vietnamese) 01/05/2024 SUDRS057_V SUDRS057_S SUDRS Discharge Plan (Spanish) 01/05/2024 SUDRS057_S SUDRS057_M SUDRS Discharge Plan (Mandarin) 01/05/2024 SUDRS057_M Contingency Management: Recovery Incentives Program Consent Form (Vietnamese) 01/05/2024 SUDRS054 Contingency Management: Recovery Incentives Program Consent Form (Mandarin) 01/05/2024 SUDRS054 Electroconvulsive Therapy (ECT) Referral Form 01/17/2024 MDS040 Controlled Substance Count Sheet 05/16/2024 MDS041 Trainee Statement of Awareness 04/17/2024 HR025 Threat Incident Against County of San Bernadino Employees 09/04/2024 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 05/01/2024 MDS2033-2 Access and Amendment of Medical Records Procedure 07/14/2008 COM0932 Clinical Laboratory Registration Procedure 05/01/2023 MDS2033-1 Workstation and Data Security Policy 08/13/2024 IT5022 Clinical Laboratory Registration Policy 04/27/2023 MDS2033 Utilization Management, Audit, Oversight, Recoupment Standards for Specialty Mental Health Services 03/02/2023 QM6058 Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services 03/02/2023 QM6059 Single Case Agreement Policy 04/17/2024 SUDRS0245 Single Case Agreement Procedure 04/17/2024 SUDRS0245-1 Utilization Management, Audit, Oversight and Recoupment Standards for Substance Use Disorder Service 03/02/2023 SUDRS0244 Hybrid Telework Policy 11/30/2022 HR4032 Hybrid Telework Procedure 11/30/2022 HR4032-1 Emotional Support Animal Clinical Documentation Policy 10/12/2022 CLP0843 Continuity of Care Procedure 07/18/2022 QM6044-2 Network Adequacy Policy 05/17/2021 QM6043 DMC-ODS Requirements for period 2022-2026 08/08/2022 SUDRS0241 Documentation Requirements for all SMHS DMC and DMC-ODS Services 07/28/2022 QM6056 Transition of Care Procedure 07/18/2022 QM6044-3 Clinical Supervision for Pre-Licensed Psychologists 02/16/2022 CLP0842 Data Sanitization Policy 09/25/2024 IT5016 DBH-IT Data Encryption 02/28/2022 IT5018 DATAR Policy (SUDRS0236) 08/29/2023 SUDRS0236 DATAR Procedure (SUDRS0236-1) 08/28/2023 SUDRS0236-1 Transition to Higher Level of Care Procedure 09/18/2024 SUDRS0226-1 Transition to Higher Level of Care Policy 09/18/2024 SUDRS0226 Request to Change the DBH Websites Policy (BOP3047) 12/20/2022 BOP3047 Request to Change the DBH Websites Procedure (BOP3047-1) 12/20/2022 BOP3047-1 Physician Consultation Services 09/13/2021 SUDRS0224 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 Medication Policy for Clients Seeking SUD Services 08/27/2024 SUDRS0210 Youth Substance Use Disorder Crisis Intervention Policy 07/24/2023 SUDRS0212 Perinatal Treatment 01/19/2023 SUDRS0213 Admission Preference and Interim Services Policy 09/13/2021 SUDRS0214 Admission Preference and Interim Services Procedure SUDRS0214-1 Accessibility of Services Policy 08/15/2022 SUDRS0220 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 Measurements System (CalOMS) Monthly Reporting Policy 08/02/2024 SUDRS0229 California Outcomes Measurement System 04/13/2022 SUDRS0229-1 Post Client Satisfaction Survey Procedure 05/13/2021 SUDRS0230 Substance Use Disorder And Recovery Services Residential Prior Authorization Policy 05/13/2021 SUDRS0231 Case Management Services For Child And Adolescent Clients 05/13/2021 CHD0302 Child Abuse Reporting Policy 05/13/2021 CHD0303 Child Abuse Reporting Procedure 05/13/2021 CHD0303-1 Ab 2726 Program Policy 05/13/2021 CHD0307 Financial Interviewer Procedure 05/13/2021 CHD0308 Healthy Families Sed Services Policy 05/13/2021 CHD0309 Healthy Families Sed Services Procedure 05/13/2021 CHD0309-1 Providing Services To Foster Care, Adoption Assistance Program (aap) And Kinship Guardianship Assistance Payment (kingap) Children Placed Out-of County Policy 05/13/2021 CHD0311 Services for Children Placed Out-of-County, Foster, and Probationary Youth Procedure 02/16/2023 CHD0311-1 Providing Services To Adoption Assistance Program (aap) And Kinship Guardianship Assistance Payment (kingap) Children Placed Out-of County Procedure 05/13/2021 CHD0311-2 Children’s Fund Immediate Need Voucher Policy 05/13/2021 CHD0315 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 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 Com0914-code-of-conduct-policy 07/11/2024 COM0914 Certification Of Billed Services 05/13/2021 COM0915 Compliance Verification, Monitoring And Auditing Policy 05/13/2021 COM0917 Compliance Hotline Policy 05/13/2021 COM0919 Compliance Hotline Procedure 05/13/2021 COM0919-1 Dbh Compliance Committee 05/13/2021 COM0920 Sound And Photographic Recordings Policy 05/13/2021 COM0922 Security Of Protected Electronic Health Information Policy 05/13/2021 COM0923 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 System (MEDSLITE) Policy 02/08/2024 COM0943 Medi-cal Eligibility Data System (MEDSLITE) Procedure 02/08/2024 COM0943-1 Privacy Incident Policy 02/26/2024 COM0944 Client Grievance Policy 05/13/2021 COM0946 Mhsa Issue Resolution Process 05/13/2021 COM0947 Transportation Of Protected Health Information (phi) Policy 05/13/2021 COM0948 Transportation Of Protected Health Information (phi) Procedure 05/13/2021 COM0948-1 Non-Discrimination of Clients (Affordable Care Act) Policy 12/21/2023 COM0953 Affordable Care Act (ACA) 1557 Grievance Procedure 05/13/2021 COM0953-1 Overpayment Policy 05/13/2021 COM0954 Behavioral Health Services For Clients/family 05/17/2021 CUL1002 Behavioral Health Services For Clients/family 05/17/2021 CUL1002-1 Satisfying Clients’ Language Needs 05/17/2021 CUL1004 Consumer Focus Group Policy 05/17/2021 CUL1005 Consumer Focus Group Procedure 05/17/2021 CUL1005-1 Cultural Competency Policy 05/17/2021 CUL1006 Field Testing Of Written Materials Policy 05/17/2021 CUL1010 Field Testing Of Written Materials Procedure 05/17/2021 CUL1010-1 Providing Translation Services Procedure 05/17/2021 CUL1011 Providing Interpretation Services Procedure 06/13/2022 CUL1012 Language Serice Guide for Translations 02/16/2024 CUL1013 Cultural Competency Training Policy 05/17/2021 CUL1014 Medical Services Staff Organization 05/17/2021 MDS2002 Incorporated Employees – Fiscal Control Procedures 05/17/2021 MDS2003 Guidelines For Psychiatrists Assigned To Outpatient Clinics 05/17/2021 MDS2004 Leave Of Absence – Physicians 05/17/2021 MDS2005 Deviation From Standard Of Practice Of Medicine 05/17/2021 MDS2006 Benzodiazepine Medication Policy 05/17/2021 MDS2007 Control, Access and Accountability of Medications and Medical Supplies Policy 12/15/2022 MDS2008 Control, Access and Accountability of Medications and Medical Supplies Procedure 12/15/2022 MDS2008-1 Controlled Substance Utilization Review And Evaluation System (cures) Policy 05/17/2021 MDS2010 Controlled Substance Utilization Review And Evaluation System (cures) Procedure 05/17/2021 MDS2010-1 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 07/16/2024 HR4012 Volunteer Policy 05/17/2021 HR4013 Volunteer Request And Registration Procedure 05/17/2021 HR4013-1 Non-discrimination / Equal Employment Opportunity 05/17/2021 HR4015 Dress and Grooming Policy 05/14/2024 HR4016 Personnel Records 05/17/2021 HR4018 Telephone Calls – Personal 05/17/2021 HR4019 Smoking And Tobacco Use Policy 05/17/2021 HR4020 Time And Attendance Form – How To Complete 05/17/2021 HR4021 Time And Attendance Correction 05/17/2021 HR4021-1 Vacation Leave – Request 05/17/2021 HR4023 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 05/17/2021 IT5009 Superseded by myAvatar User Account Creation and Reinstatement Procedure 12/15/2021 IT5012-5 Medi-Cal Site Certification Policy 07/22/2022 QM6002 Medi-Cal Site Certification Procedure 07/22/2022 QM6002-1 Qshort-doyle And Short-doyle/medi-cal Clinic Change Of Ownership Or Location 05/17/2021 QM6003 Research And Evaluation Functions 05/17/2021 QM6004 Research Review Committee 05/17/2021 QM6005 Requesting an Initial Choice of Provider or Change of Provider Procedure 07/19/2022 QM6006-1 Requesting an Initial Choice of Provider or Change of Provider Policy 07/19/2022 QM6006 Credentialing Policy 05/17/2021 QM6008 Credentialing Procedure 05/17/2021 QM6008-1 Quality Management Committee Membership/participation 05/17/2021 QM6009 Written Informing Materials Policy 05/17/2021 QM6012 Post State Audit Procedures 05/17/2021 QM6014 Pre State Chart Audit Responsibilities & Procedures 05/17/2021 QM6015 Billing Guidelines For Quality Assurance Activities 05/17/2021 QM6019 Outpatient Chart Audit – Site Review Policy 05/17/2021 QM6020 Investigating And Reporting Death Of A Dbh Client 05/17/2021 QM6021 Quality Of Care Referral Policy 05/17/2021 QM6022 Quality Of Care Referral Procedure 05/17/2021 QM6022-1 Samhsa Block Grant-annual Program Review Procedure 05/17/2021 QM6024 Fee-for Service Credentialing Procedure 05/17/2021 QM6026 Dbh Provider Directories Policy 05/17/2021 QM6027 Grievance and Appeal Policy 09/19/2022 QM6029 Grievance Procedure 05/17/2021 QM6029-1 State Hearing Procedure 05/17/2021 QM6029-2 Standard And Expedited Resolution Of Appeals Procedure 05/17/2021 QM6029-3 Noabd Procedure 05/17/2021 QM6029-4 Research Policy 05/17/2021 QM6032 Service Delivery Definition Policy 05/17/2021 QM6036 Consistency in Inpatient and Outpatient Utilization Review and Authorization Practices Policy 07/19/2022 QM6038 Consistency in Inpatient Utilization Review and Authorization Practices Procedure 07/19/2022 QM6038-1 Consistency in Outpatient Utilization Review and Authorization Practices Procedure 07/19/2022 QM6038-2 Mhp Point Of Authorization Plan For Inpatient Psychiatric Hospitalization Protocol 05/17/2021 QM6039 Tier Transition Protocol 05/17/2021 QM6040 Timely Access Procedure 08/18/2022 QM6041-1 Timely Access Policy 07/19/2022 QM6041 Network Adequacy Procedure 05/17/2021 QM6043-1 Out of Network Policy 07/18/2022 QM6044 Out of Network Access Procedure 07/18/2022 QM6044-1 24/7 Access Line Requirements Policy 07/20/2022 QM6045 24/7 Access Line Requirements Procedure 07/20/2022 QM6045-1 Service Availability Policy 07/19/2022 QM6046 Selection And Retention Of Network Provider Policy 05/17/2021 QM6048 Department Liability For Employees And Volunteers’ Action Outside Work 05/18/2021 SFT7002 Bomb Threat Procedure 05/18/2021 SFT7005 Earthquake Procedures 05/18/2021 SFT7006 Disaster And Mass Casualty Policy 05/18/2021 SFT7007 Air Pollution Emergency Episode Plan 05/18/2021 SFT7008 Assaultive Behavior Plan (abp) Policy 05/18/2021 SFT7009 Possession of a Weapon Policy 07/05/2024 SFT7010 Assaultive Behavior Plan (abp) Procedure 05/18/2021 SFT7009-1 12/21/2022 SFT7010 Possession of a Weapon Procedure 07/05/2024 SFT7010-1 Safety And Emergency Coordination Policy 05/18/2021 SFT7011 Electrical Safety Policy: Personal Appliances 05/18/2021 SFT7012 Safety In The Field Procedure 05/18/2021 SFT7013 Threats Against Federal Or State Officials Policy 05/18/2021 SFT7014 Threats And Assault On Dbh Staff Policy 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 03/20/2023 MDS2032 Naloxone Intranasal Distribution Procedure 03/20/2023 MDS2032-1 Advance Health Care Directive 09/23/2021 COM005 Remote Access Policy 09/28/2021 IT5006 Client Tuberculosis (TB) Testing and Services Policy 11/03/2021 SUDRS0219 Client Tuberculosis (TB) Testing and Services Procedure 11/03/2021 SUDRS0219-1 myAvatar Electronic Health Records Policy 12/15/2021 IT5012 myAvatar User Account Request Procedure 12/15/2021 IT5012-1 myAvatar User Account Creation and Reinstatement Procedure 12/15/2021 IT5012-2 myAvatar User Account Modification Procedure 12/15/2021 IT5012-3 myAvatar User Account Deactivation Procedure 12/15/2021 IT5012-4 Criteria for Beneficiary Access to SMHS Medical Necessity and other Requirements 06/14/2022 QM6054 Medication Support Only Case Policy 06/22/2022 MDS2009 No Wrong Door for Mental Health Services Policy 07/01/2022 QM6055 Test Call Policy 07/20/2022 QM6057 Fentanyl Test Strips Project Policy 11/30/2022 SUDRS0243 Fentanyl Test Strips Project Procedure 11/30/2022 SUDRS0243-1 Privacy/Security Incident Report HSPSP 1503 County Behavioral Health Intergovernmental Transfers (IGT) 08/28/2023 BOP3050 Contingency Management: Recovery Incentives Program Policy 09/08/2023 SUDRS0248 Contingency Management: Recovery incentives Program Monitoring Procedure 09/08/2023 SUDRS0248-1 Contingency Management: Recovery Incentives Provider Procedure 09/08/2023 SUDRS0248-2 Contingency Management: Recovery Incentives Program Urine Drug test (UDT) Procedure 09/08/2023 SUDRS0248-3 Adolescent SUD Best Practices 09/14/2023 SUDRS0247 Pre-Award Financial Risk Assessment Procedure 09/26/2023 SUDRS0246-1 Pre-Award Financial Risk Assessment Policy 09/26/2023 SUDRS0246 Electroconvulsive Therapy (ECT) Referral and Payment Authorization Policy 01/17/2024 MDS2026 Electroconvulsive Therapy (ECT) Referral and Payment Authorization Procedure 01/17/2024 MDS2026-1 Medication Assisted Treatment Policy 05/02/2024 SUDRS0252 Medication Assisted Treatment Procedure 05/02/2024 SUDRS0252-1 Type Name Modified Date Notice Number My Avatar ICL Update 06/05/2024 IN 23-04 Notice to Patients 04/04/2023 IN 23-01 DBH and BBS Complaint Notification to Client 07/16/2024 IN 23-03 Status of COVID-19 Emergency Health Care Flexibilities 04/03/2023 IN 23-02 Evaluation Code Changes 01/21/2021 IN 20-09 Revised Mental Health Co-Staffing Chart Documentation a 07/01/2020 IN 20-07 Personal Protective Equipment (PPE) for DBH Programs 06/01/2020 IN 20-06 Quality Management Chart Documentation Guidance due to 05/01/2020 IN 20-05 A1 DUI Guidance due to COVID-19 05/01/2020 IN 20-05 A2 NTP Guidance due to COVID-19 05/01/2020 IN 20-05 Administration Guidance due to COVID-19 05/01/2020 IN 20-05 New Classification of Other Qualified Providers 02/01/2020 IN 20-02 Suicide Prevention Training Requirement 01/01/2020 IN 20-01 Coronavirus (COVID-19) Information for DBH Workforce 08/11/2021 IN 20-04 Mental Health Consumer Perception Survey – Spring 2019 08/12/2021 IN 19-01 DMC-ODS UCLA Treatment Perception Survey-October 2019 08/12/2021 IN 19-02 Notice of Changes to EPSDT Data Collection Requirements 08/12/2021 IN 19-04 Approved Abbreviations New! 08/12/2021 IN 19-05 Editing Notice of Adverse Benefit Determination (NOABD) 08/12/2021 IN 19-06 Mental Health Consumer Perception Survey-Fall 2019 New! 08/12/2021 IN 19-07 Consolidation of Electronic Signature (E-Signature) 08/12/2021 IN 19-08 New Medicare Beneficiary Identifier (MBI) New! 08/12/2021 IN 19-09 Network Adequacy Requirements and Deadline (03/01/2018) 08/12/2021 IN 18-01 Updated Authorization to Release Protected Health Info 08/12/2021 IN 18-02 Child and Adolescent Needs and Strengths (CANS)(PSC-35) 08/12/2021 IN 18-03 UCLA Treatment Perceptions Survey Information (9/20/18) 08/12/2021 IN 18-04 Mental Health Consumer Perception Survey – Fall 2018 08/12/2021 IN 18-05 Office Configuration Safety Standards (12/18/2018) New! 08/12/2021 IN 18-06 Standing Order Requirement for Administering NARCAN 08/12/2021 IN 18-08 Disaster Response Requirements (02/01/2017) New! 08/12/2021 IN 17-01 Revised Child/Adolescent Psychiatric Evaluation CLP014 08/12/2021 IN 17-02 SIMON Update (03/01/2017) New! 08/12/2021 IN 17-03 Regulations Regarding Welfare and Institutions Code WIC 08/12/2021 IN 17-05 CLP015-1 Child/Adolescent Assessment-CANS-SB 05/02/2017 08/12/2021 IN 17-07 Implementation of the Diagnostic and Statistical Manual 08/12/2021 IN 17-09 Medicaid Managed Care Final Rule Implementation 08/12/2021 IN 17-10 Confidentiality Statement Requirement for Safeguarding 08/12/2021 IN 17-11 Oath of Confidentiality (Contractors) 01/14/2022 IN 17-11 Appendix A Implementation of Title Change of Marriage and Family 08/12/2021 IN 17-12 Psychiatric Mental Health Nurse Practitioners 08/12/2021 IN 17-14 New Mental Health Procedure Codes (10/13/2016) 08/12/2021 IN 16-03 Outpatient Chart Manual and Scope of Practice Guide 08/12/2021 IN 16-02 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 Refere
