Documents

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

Name	Modified Date	Program and Number
Notice to Patient Client – English	06/14/2023	MDS030
Notice to Patient Client – Spanish	06/14/2023	MDS030_S
Notice to Patient Client – Mandarin	06/14/2023	MDS030_M
Notice to Patient Client – Vietnamese	06/14/2023	MDS030_V
Notice to Patient Client D.O. – English	06/14/2023	MDS031
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	05/09/2022	SUDRS044
Consent for SUD Care Coordination Services (Spanish)		SUDRS035_S
Care Coordination Needs Determination Screening Tool (English)		SUDRS036_E
SUD Care Coordination Needs Determination Screening Tool (Spanish)		SUDRS036_S
SUD Care Coordination Plan (English)	06/01/2023	SUDRS037_E
SUD Care Coordination Plan (Vietnamese)	06/01/2023	SUDRS037_V
SUD Care Coordination Plan (Mandarin)	06/01/2023	SUDRS037_M
SUD Care Coordination Plan (Spanish)	06/01/2023	SUDRS037_S
Care Coordination Discharge Summary (English)		SUDRS038_E
Care Coordination Discharge Summary (Spanish)		SUDRS038_S
CalOMS Administrative Discharge		SUDRS045
CalOMS Admission		SUDRS046
CalOMS Admission Instructions		SUDRS047
CalOMS Standard Discharge		SUDRS048
CalOMS Standard Discharge Instructions		SUDRS049
Privacy and Security Incident Reporting Form	05/03/2022	COM042
Medi Cal Fee For Service Provider Manual		MHPFFS51319
DBH Discipline – Taxonomy Codes	03/11/2024
Staff Master Worksheet Update
Staff Master Worksheet
Mental Health Professional Licensing Waiver Request	08/30/2022	DHCS 1739
Title 22 Fair Hearing Rights	01/31/2023	SUDRS002_E
Title 22 Fair Hearing Rights (Spanish)	01/31/2023	SUDRS002_S
Title 22 Fair Hearing Rights (Mandarin)	01/31/2023	SUDRS002_M
Title 22 Fair Hearing Rights (Vietnamese)	01/31/2023	SUDRS002_V
Notice of Personal Rights / Civil Rights	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	06/01/2024	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	06/01/2024	SUDRS031
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS033.pdf	05/10/2021	SUDRS033
SUD Referral	11/15/2023	SUDRS034
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS039.pdf	05/10/2021	SUDRS039
ASAM Level of Care	03/07/2024	SUDRS042
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS050.pdf	05/10/2021	SUDRS050
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS051.pdf	05/10/2021	SUDRS051
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS052-.pdf	05/10/2021	SUDRS052
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD012.pdf	05/11/2021	CHD012
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD013.pdf	05/11/2021	CHD013
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD014.pdf	05/11/2021	CHD014
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD025_E.pdf	05/11/2021	CHD025_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD025_S.pdf	05/11/2021	CHD025_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP_CODES.pdf	05/11/2021	CLP_CODES
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP001.pdf	05/11/2021	CLP001
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP002.pdf	05/11/2021	CLP002
Initial Contact Form (English)	08/26/2021	CLP003_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP003_S.pdf	05/11/2021	CLP003_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP004.pdf	05/11/2021	CLP004
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP005.pdf	05/11/2021	CLP005
Universal Charge Data Invoice	06/13/2022	CLP006
Charge Data Invoice	02/15/2022	CLP009
Client Resource Evaluation	02/15/2022	CLP012
Adult Psychiatric Evaluation (Fillable)	02/15/2022	CLP013 (Fill)
Adult Psychiatric Evaluation (Fillable)	02/15/2022	CLP013 (Print)
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP014.pdf	05/11/2021	CLP014
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP015.pdf	05/11/2021	CLP015
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP015-1-Child-Adol-Clinical_Assessment_CANS-SB.pdf	05/11/2021	CLP015-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP016.pdf	05/11/2021	CLP016_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP016_S.pdf	05/11/2021	CLP016_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP017.pdf	05/11/2021	CLP017
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP018.pdf	05/11/2021	CLP018
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP019.pdf	05/11/2021	CLP019
Psychological Testing Referral Form	04/13/2022	CLP020
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP021.pdf	05/11/2021	CLP021
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP022.pdf	05/11/2021	CLP022
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP024_E.pdf	05/11/2021	CLP024_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP024_S.pdf	05/11/2021	CLP024_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP025.pdf	05/11/2021	CLP025
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP026.pdf	05/11/2021	CLP026
Interdisciplinary Note	02/15/2022	CLP027
Services Teams Actions	05/17/2023	CLP028
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP029_E.pdf	05/11/2021	CLP029_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP029_S.pdf	05/11/2021	CLP029_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP030.pdf	05/11/2021	CLP030
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP031.pdf	05/11/2021	CLP031
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP035.pdf	05/11/2021	CLP035_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP035_S.pdf	05/11/2021	CLP035_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP042.pdf	05/11/2021	CLP042_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP042_S.pdf	05/11/2021	CLP042_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP043.pdf	05/11/2021	CLP043
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP044.pdf	05/11/2021	CLP044
DBH 5150/5585 Assessment/Evaluation/Cris Form (DHCS 1801)	02/28/2024	CLP050
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP051.pdf	05/11/2021	CLP051
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM001.doc	05/11/2021	QM001
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM005.pdf	05/11/2021	QM005
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM018.pdf	05/11/2021	QM018
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM018-1.pdf	05/11/2021	QM018_1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM020_E.pdf	05/11/2021	QM020_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM020_S.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM025_E.docx	05/11/2021	QM025_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM025_S.doc	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM044.pdf	05/11/2021	QM044
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM046.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM049.pdf	05/11/2021	QM049
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM050_E.pdf	05/11/2021	QM050_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM050_S.pdf	05/11/2021	QM050_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM051_E.pdf	05/11/2021	QM051_Et
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM056.pdf	05/11/2021	QM056
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM057.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM059_S.doc	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM075.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK003.doc	05/11/2021	CLK003
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK004.doc	05/11/2021	CLK004
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK006.pdf	05/11/2021	CLK006
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK028.pdf	05/11/2021	CLK028
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK028_S.pdf	05/11/2021	CLK028_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK029.pdf	05/11/2021	CLK029
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK029_S.pdf	05/11/2021	CLK029_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK030.pdf	05/11/2021	CLK030
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK030_S.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM006.pdf	05/11/2021	COM006
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM007.pdf	05/11/2021	COM007
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM010.pdf	05/11/2021	COM010
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM012.pdf	05/11/2021	COM012
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM013_E.pdf	05/11/2021	COM013_Et
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM013_S.pdf	05/11/2021	COM013_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM013_V.pdf	05/11/2021	COM013_V
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM014_E.pdf	05/11/2021	COM014_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM014_S.pdf	05/11/2021	COM014_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM015_E.pdf	05/11/2021	COM015_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM015_S.pdf	05/11/2021	COM015_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM016_E.pdf	05/11/2021	COM016_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM016_S.pdf	05/11/2021	COM016_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM018_E.pdf	05/11/2021	COM018_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM018_S.pdf	05/11/2021	COM018_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM019.pdf	05/11/2021	COM019
Conflict of Interest Disclosure Statement	07/27/2022	COM020
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM021_E.pdf	05/11/2021	COM021_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM021_S.pdf	05/11/2021	COM021_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM023_E.pdf	05/11/2021	COM023_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM023_S.pdf	05/11/2021	COM023_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM024_E.pdf	05/11/2021	COM024_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM024_S.pdf	05/11/2021	COM024_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM026_E.pdf	05/11/2021	COM026_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM026_S.pdf	05/11/2021	COM026_S
Oath of Confidentiality	01/14/2022	COM027
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM028_E.pdf	05/11/2021	COM028_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM028_S.pdf	05/11/2021	COM028_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM028_V.pdf	05/11/2021	COM028_V
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM033.pdf	05/11/2021	COM033
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM034.pdf	05/11/2021	COM034
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM035.pdf	05/11/2021	COM035
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM036.pdf	05/11/2021	COM036
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM037.pdf	05/11/2021	COM037
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM038_E.pdf	05/11/2021	COM038
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM038_S.pdf	05/11/2021	COM038_S
Electronic Signature Agreement and E-Signature and Provider Signature List	02/17/2023	COM039
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM040_E.pdf	05/11/2021	COM040_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM040_S.pdf	05/11/2021	COM040_S
myAvatar Policy/Procedure Acknowledgement Form	12/27/2022	COM041
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/PR001_E.pdf	05/11/2021	PR001_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/PR001_S.pdf	05/11/2021	PR001_S
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/PR002_E.pdf	05/11/2021	PR002_E
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/PR002_S.pdf	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	01/05/2024	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

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
Clinical Laboratory Registration Procedure	05/01/2023	MDS2033-1
Clinical Laboratory Registration Policy	04/27/2023	MDS2033
Utilization Management, Audit, Oversight, Recoupment Standards for Specialty Mental Health Services	03/02/2023	QM6058
Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services	03/02/2023	QM6059
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
DBH-IT Data Encryption	02/28/2022	IT5018
DATAR Policy (SUDRS0236)	08/29/2023	SUDRS0236
DATAR Procedure (SUDRS0236-1)	08/28/2023	SUDRS0236-1
Request to Change the DBH Websites Policy (BOP3047)	12/20/2022	BOP3047
Request to Change the DBH Websites Procedure (BOP3047-1)	12/20/2022	BOP3047-1
Physician Consultation Services	09/13/2021	SUDRS0224
Scope of Practice Billing Guide
Outpatient Chart Manual
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/ADT0101.pdf	05/13/2021	ADT0101
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/ADT0102.pdf	05/13/2021	ADT0102
Reporting Dependent Adult/Elder Abuse and Neglect Policy		ADT0103
Reporting Dependent Adult/Elder Abuse and Neglect Procedure		ADT0103-01
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/ADT0105.pdf	05/13/2021	ADT0105
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/ADT0106.pdf	05/13/2021	ADT0106
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/ADS201.pdf	05/13/2021	ADS0201
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/ADS0202.pdf	05/13/2021	ADS0202
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/ADS0205.pdf	05/13/2021	ADS0205
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/ADS0209-1.pdf	10/06/2021	SUDRS0209-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/ADS0210.pdf	05/13/2021	ADS0210
Youth Substance Use Disorder Crisis Intervention Policy	07/24/2023	SUDRS0212
Perinatal Treatment	01/19/2023	SUDRS0213
Admission Preference and Interim Services Policy	09/13/2021	SUDRS0214
Admission Preference and Interim Services Procedure		SUDRS0214-1
Accessibility of Services Policy	08/15/2022	SUDRS0220
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/ADS0221.pdf	05/13/2021	ADS0221
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS0223.pdf	05/13/2021	SUDRS0223
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS0225.pdf	05/13/2021	SUDRS0225
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS0228.pdf	05/13/2021	SUDRS0228
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS0228-1.pdf	05/13/2021	SUDRS0228-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS0229.pdf	05/13/2021	SUDRS0229
California Outcomes Measurement System	04/13/2022	SUDRS0229-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS0230.pdf	05/13/2021	SUDRS0230
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SUDRS0231.pdf	05/13/2021	SUDRS0231
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0302.pdf	05/13/2021	CHD0302
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0303.pdf	05/13/2021	CHD0303
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0303-1.pdf	05/13/2021	CHD0303-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0307.pdf	05/13/2021	CHD0307
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0308.pdf	05/13/2021	CHD0308
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0309.pdf	05/13/2021	CHD0309
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0309-1.pdf	05/13/2021	CHD0309-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0311.pdf	05/13/2021	CHD0311
Services for Children Placed Out-of-County, Foster, and Probationary Youth Procedure	02/16/2023	CHD0311-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0311-2.pdf	05/13/2021	CHD0311-2
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0315.pdf	05/13/2021	CHD0315
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0315-1.pdf	05/13/2021	CHD0315-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0316.pdf	05/13/2021	CHD0316
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0316-1.pdf	05/13/2021	CHD0316-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CHD0316-2.pdf	05/13/2021	CHD0316-2
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/OCM.pdf	05/13/2021	OCM
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK0701.pdf	05/13/2021	CLK0701
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK0702.pdf	05/13/2021	CLK0702
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK0703.pdf	05/13/2021	CLK0703
Charge Data Invoice (CDI) Process	03/23/2023	CLK0704
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK0705.pdf	05/13/2021	CLK0705
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK0707.pdf	05/13/2021	CLK0707
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK0708.pdf	05/13/2021	CLK0708
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK0711.pdf	05/13/2021	CLK0711
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK0712.pdf	05/13/2021	CLK0712
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK0713.pdf	05/13/2021	CLK0713
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLK0714.pdf	05/13/2021	CLK0714
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0802.pdf	05/13/2021	CLP0802
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0804.pdf	05/13/2021	CLP0804
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0805.pdf	05/13/2021	CLP0805
Clinical Supervision for Licensure AMFT, ACSW, APCC	02/16/2022	CLP0806
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0807.pdf	05/13/2021	CLP0807
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0808.pdf	05/13/2021	CLP0808
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0809.pdf	05/13/2021	CLP0809
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0810.pdf	05/13/2021	CLP0810
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0812.pdf	05/13/2021	CLP0812
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0814.pdf	05/13/2021	CLP0814
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0815.pdf	05/13/2021	CLP0815
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0816.pdf	05/13/2021	CLP0816
Authorization and Designation Pursuant to the Lanterman-Petris-Short (LPS) Act	09/06/2022	CLP0818
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0819.pdf	05/13/2021	CLP0819
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0819-1.pdf	05/13/2021	CLP0819-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0821.pdf	05/13/2021	CLP0821
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0822.pdf	05/13/2021	CLP0822
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0824.pdf	05/13/2021	CLP0824
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0826.pdf	05/13/2021	CLP0826
Veterans Services Policy	09/26/2022	CLP0828
Veterans Services Procedure	09/26/2022	CLP0828-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0829.pdf	05/13/2021	CLP0829
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0829-1.pdf	05/13/2021	CLP0829-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0830.pdf	05/13/2021	CLP0830
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0831.pdf	05/13/2021	CLP0831
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0832.pdf	05/13/2021	CLP0832
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0833.pdf	05/13/2021	CLP0833
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0834.pdf	05/13/2021	CLP0834
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0834-1.pdf	05/13/2021	CLP0834-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0836.pdf	05/13/2021	CLP0836
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CLP0836-1.pdf	05/13/2021	CLP0836-1
Client Notice Regarding Termination of Provider Procedure	04/12/2022	CLP0837
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0901.pdf	05/13/2021	COM0901
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0902.pdf	05/13/2021	COM0902
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0903.pdf	05/13/2021	COM0903
Medical Record Security Policy for Outpatient Services	08/30/2022	COM0904
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0905.pdf	05/13/2021	COM0905
Retention of Medical Records Policy	04/03/2023	COM0906
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0907.pdf	05/13/2021	COM0907
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0908.pdf	05/13/2021	COM0908
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0908-1.pdf	05/13/2021	COM0908-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0909.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0913.pdf	05/13/2021	COM0913
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0914-Code-of-Conduct-Policy.pdf	07/11/2024	COM0914
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0915.pdf	05/13/2021	COM0915
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0917.pdf	05/13/2021	COM0917
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0919.pdf	05/13/2021	COM0919
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0919-1.pdf	05/13/2021	COM0919-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0920.pdf	05/13/2021	COM0920
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0922.pdf	05/13/2021	COM0922
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0923.pdf	05/13/2021	COM0923
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0924.pdf	05/13/2021	COM0924
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0925.pdf	05/13/2021	COM0925
Privacy and Security Incident Sanctions	01/19/2022	COM0926
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0927.pdf	05/13/2021	COM0927
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0931.pdf	05/13/2021	COM0931
Ineligible Persons Procedure	08/11/2022	COM0933-1
Ineligible Persons Policy	08/11/2022	COM0933
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0934.pdf	05/13/2021	COM0934
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0935.pdf	05/13/2021	COM0935
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0935-1.pdf	05/13/2021	COM0935-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0935-2.pdf	05/13/2021	COM0935-2
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0938.pdf	05/13/2021	COM0938
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0938-1.pdf	05/13/2021	COM0938-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0939.pdf	05/13/2021	COM0939
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0941.pdf	05/13/2021	COM0941
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0942.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0946.pdf	05/13/2021	COM0946
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0947.pdf	05/13/2021	COM0947
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0948.pdf	05/13/2021	COM0948
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0948-1.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/COM0954.pdf	05/13/2021	COM0954
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CUL1002.pdf	05/17/2021	CUL1002
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CUL1002-1.pdf	05/17/2021	CUL1002-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CUL1004.pdf	05/17/2021	CUL1004
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CUL1005.pdf	05/17/2021	CUL1005
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CUL1005-1.pdf	05/17/2021	CUL1005-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CUL1006.pdf	05/17/2021	CUL1006
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CUL1010.pdf	05/17/2021	CUL1010
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CUL1010-1.pdf	05/17/2021	CUL1010-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CUL1011.pdf	05/17/2021	CUL1011
Providing Interpretation Services Procedure	06/13/2022	CUL1012
Language Serice Guide for Translations	02/16/2024	CUL1013
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/CUL1014.pdf	05/17/2021	CUL1014
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2002.pdf	05/17/2021	MDS2002
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2003.pdf	05/17/2021	MDS2003
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2004.pdf	05/17/2021	MDS2004
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2005.pdf	05/17/2021	MDS2005
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2006.pdf	05/17/2021	MDS2006
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2007.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2010.pdf	05/17/2021	MDS2010
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2010-1.pdf	05/17/2021	MDS2010-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2011.pdf	05/17/2021	MDS2011
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2012.pdf	05/17/2021	MDS2012
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2014.pdf	05/17/2021	MDS2014
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2015.pdf	05/17/2021	MDS2015
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2016.pdf	05/17/2021	MDS2016
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2017.pdf	05/17/2021	MDS2017
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2018.pdf	05/17/2021	MDS2018
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2019.pdf	05/17/2021	MDS2019
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2019-1.pdf	05/17/2021	MDS2019-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2020.pdf	05/17/2021	MDS2020
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2021.pdf	05/17/2021	MDS2021
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2022.pdf	05/17/2021	MDS2022
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2022-1.pdf	05/17/2021	MDS2022-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2025.pdf	05/17/2021	MDS2025
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2027.pdf	05/17/2021	MDS2027
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2027-1.pdf	05/17/2021	MDS2027-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2028.pdf	05/17/2021	MDS2028
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2028-1.pdf	05/17/2021	MDS2028-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/MDS2029.pdf	05/17/2021	MDS2029
Urgent and Emergency Conditions Procedure	07/18/2022	MDS2031
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/NUR2101.pdf	05/17/2021	NUR2101
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3001.pdf	05/17/2021	BOP3001
Requests to Modify Standard Practice Manual Procedure	10/20/2021	BOP3002
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3003.pdf	05/17/2021	BOP3003
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3004.pdf	05/17/2021	BOP3004
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3005.pdf	05/17/2021	BOP3005
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3006.pdf	05/17/2021	BOP3006
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3007.pdf	05/17/2021	BOP3007
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3009.pdf	05/17/2021	BOP3009
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3010.pdf	05/17/2021	BOP3010
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3011.pdf	05/17/2021	BOP3011
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3012.pdf	05/17/2021	BOP3012
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3013.pdf	05/17/2021	BOP3013
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3014.pdf	05/17/2021	BOP3014
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3014-1.pdf	05/17/2021	BOP3014-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3015.pdf	05/17/2021	BOP3015
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3015-1.pdf	05/17/2021	BOP3015-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3016.pdf	05/17/2021	BOP3016
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3017.pdf	05/17/2021	BOP3017
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3018.pdf	05/17/2021	BOP3018
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3019.pdf	05/17/2021	BOP3019
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3020.pdf	05/17/2021	BOP3020
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3021.pdf	05/17/2021	BOP3021
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3022.pdf	05/17/2021	BOP3022
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3023.pdf	05/17/2021	BOP3023
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3024.pdf	05/17/2021	BOP3024
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3025.pdf	05/17/2021	BOP3025
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3025-1.pdf	05/17/2021	BOP3025-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3027.pdf	05/17/2021	BOP3027
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3029.pdf	05/17/2021	BOP3029
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3029-1.pdf	05/17/2021	BOP3029-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3030.pdf	05/17/2021	BOP3030
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3030-1.pdf	05/17/2021	BOP3030-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3031.pdf	05/17/2021	BOP3031
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3032.pdf	05/17/2021	BOP3032
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3032-1.pdf	05/17/2021	BOP3032-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3033.pdf	05/17/2021	BOP3033
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3033-1.pdf	05/17/2021	BOP3033-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3033-2.pdf	05/17/2021	BOP3033-2
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3033-3.pdf	05/17/2021	BOP3033-3
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3033-4.pdf	05/17/2021	BOP3033-4
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3037.pdf	05/17/2021	BOP3037
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3040.pdf	05/17/2021	BOP3040
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3040-1.pdf	05/17/2021	BOP3040-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3042.pdf	05/17/2021	BOP3042
Web Blast Policy	12/20/2022	BOP3045
Web Blast Procedure	12/20/2022	BOP3045-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3046.pdf	05/17/2021	BOP3046
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/BOP3046-1.pdf	05/17/2021	BOP3046-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4002.pdf	05/17/2021	HR4002
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4003.pdf	05/17/2021	HR4003
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4004.pdf	05/17/2021	HR4004
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4006.pdf	05/17/2021	HR4006
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4007.pdf	05/17/2021	HR4007
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4008.pdf	05/17/2021	HR4008
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4008-1.pdf	05/17/2021	HR4008-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4009.pdf	05/17/2021	HR4009
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4010.pdf	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	05/06/2024	HR4012
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4013.pdf	05/17/2021	HR4013
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4013-1.pdf	05/17/2021	HR4013-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4015.pdf	05/17/2021	HR4015
Dress and Grooming Policy	05/14/2024	HR4016
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4018.pdf	05/17/2021	HR4018
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4019.pdf	05/17/2021	HR4019
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4020.pdf	05/17/2021	HR4020
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4021.pdf	05/17/2021	HR4021
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4021-1.pdf	05/17/2021	HR4021-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4023.pdf	05/17/2021	HR4023
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4025.pdf	05/17/2021	HR4025
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4026.pdf	05/17/2021	HR4026
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4026-1.pdf	05/17/2021	HR4026-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4030.pdf	05/17/2021	HR4030
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/HR4030-1.pdf	05/17/2021	HR4030-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/IT5001.pdf	05/17/2021	IT5001
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/IT5002.pdf	05/17/2021	IT5002
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/IT5003.pdf	05/17/2021	IT5003
IT5004 Computer and Network Appropriate Use Policy	08/29/2023	IT5004
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/IT5005.pdf	05/17/2021	IT5005
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/IT5007.pdf	05/17/2021	IT5007
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/IT5008.pdf	05/17/2021	IT5008
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/IT5009.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6003.pdf	05/17/2021	QM6003
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6004.pdf	05/17/2021	QM6004
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6005.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6008.pdf	05/17/2021	QM6008
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6008-1.pdf	05/17/2021	QM6008-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6009.pdf	05/17/2021	QM6009
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6012.pdf	05/17/2021	QM6012
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6014.pdf	05/17/2021	QM6014
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6015.pdf	05/17/2021	QM6015
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6019.pdf	05/17/2021	QM6019
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6020.pdf	05/17/2021	QM6020
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6021.pdf	05/17/2021	QM6021
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6022a.pdf	05/17/2021	QM6022
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6022a-1.pdf	05/17/2021	QM6022-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6024.pdf	05/17/2021	QM6024
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6026.pdf	05/17/2021	QM6026
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6027.pdf	05/17/2021	QM6027
Grievance and Appeal Policy	09/19/2022	QM6029
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6029-1.pdf	05/17/2021	QM6029-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6029-2.pdf	05/17/2021	QM6029-2
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6029-3.pdf	05/17/2021	QM6029-3
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6029-4.pdf	05/17/2021	QM6029-4
Research Policy	05/17/2021	QM6032
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6036.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6039.pdf	05/17/2021	QM6039
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6040.pdf	05/17/2021	QM6040
Timely Access Procedure	08/18/2022	QM6041-1
Timely Access Policy	07/19/2022	QM6041
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6043-1.pdf	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
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/QM6048-.pdf	05/17/2021	QM6048
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7002.pdf	05/18/2021	SFT7002
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7005.pdf	05/18/2021	SFT7005
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7006.pdf	05/18/2021	SFT7006
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7007.pdf	05/18/2021	SFT7007
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7008.pdf	05/18/2021	SFT7008
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7009.pdf	05/18/2021	SFT7009
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7009-1.pdf	05/18/2021	SFT7009-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7010.pdf	05/18/2021	SFT7010
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7010-1.pdf	05/18/2021	SFT7010-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7011.pdf	05/18/2021	SFT7011
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7012.pdf	05/18/2021	SFT7012
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7013.pdf	05/18/2021	SFT7013
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7014.pdf	05/18/2021	SFT7014
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7015.pdf	05/18/2021	SFT7015
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7015-1.pdf	05/18/2021	SFT7015-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7016.pdf	05/18/2021	SFT7016
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7017.pdf	05/18/2021	SFT7017
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7018.pdf	05/18/2021	SFT7018
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7019.pdf	05/18/2021	SFT7019
Occupational Injury or Illness Reporting Procedure		SFT7020
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7021.pdf	05/18/2021	SFT7021
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7022.pdf	05/18/2021	SFT7022
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7023.pdf	05/18/2021	SFT7023
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7024.pdf	05/18/2021	SFT7024
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7028.pdf	05/18/2021	SFT7028
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7029.pdf	05/18/2021	SFT7029
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/SFT7032.pdf	05/18/2021	SFT7032
Education and Training Policy	10/19/2021	TRA8001
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/TRA8003.pdf	05/18/2021	TRA8003
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/TRA8004.pdf	05/18/2021	TRA8004
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/TRA8005.pdf	05/18/2021	TRA8005
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/TRA8006.pdf	05/18/2021	TRA8006
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/TRA8006-1.pdf	05/18/2021	TRA8006-1
Training Coordination Policy	05/18/2021	TRA8008
Training Coordination Procedure	09/29/2021	TRA8008-1
https://wp.sbcounty.gov/dbh/wp-content/uploads/2021/05/TRA8010.pdf	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

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

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

Name	Modified Date	Program and Number
Mode and Service Function Information	12/20/2021	Fiscal
How to Document – ICL Form	06/05/2024
ICL Cheat Sheet	06/05/2024
PEI Modes of Service	12/20/2021	Fiscal
CalAIM Documentation/ IT Revenue Cycle Updates	06/27/2024
CalAim Documentation & Coding Training – SUD	06/27/2024
CalAim Documentation & Coding Training – Mental Health	06/27/2024
DHCS CalAIM Service Tables – Mental Health & SUD	07/02/2024

Spring 2024 Consumer Perception Survey Training

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

Online Surveys:

Paper Surveys:

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

If you do not wish to participate in the survey, click here. You may also find the refusal link at the UCLA website under the section titled Recording Reason Codes.

CPS Flyer Templates:

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

Additional Files: