{"id":14499,"date":"2021-05-18T16:35:43","date_gmt":"2021-05-18T23:35:43","guid":{"rendered":"https:\/\/wp.sbcounty.gov\/dbh\/?page_id=14499"},"modified":"2025-09-15T08:44:59","modified_gmt":"2025-09-15T15:44:59","slug":"consumerforms","status":"publish","type":"page","link":"https:\/\/wp.sbcounty.gov\/dbh\/consumerforms\/","title":{"rendered":"Consumer Forms"},"content":{"rendered":"\n<div data-isd-block-id='isd-slider-block_f15541b79c56ad76e02b06fc4bf0ca7d' class=\"\">\n\t\t\t<div class=\"hero-slider slider-wrapper\">\n\t\t\t<div id=\"slider-isd-slider-block_f15541b79c56ad76e02b06fc4bf0ca7d\" class=\"carousel slide slider-carousel slide half\" data-bs-ride=\"true\">\n\t\t\t\t<div class=\"carousel-inner slides-1\">\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"carousel-item active desk-center-center mobi-center-center half\" data-background=\"https:\/\/wp.sbcounty.gov\/dbh\/wp-content\/uploads\/sites\/121\/2021\/05\/Website-Sliders-2121-\u00d7-1414-px.png\"  style=\"\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"hs-slide-wrapper has-content has-overlay\">\n\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<div class=\"hs-content-wrapper left-align\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"slide-container  dark-background  rounded-corners\">\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"slide-content text-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"slide-heading\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h1 class=\"section-heading\">Consumer Forms<\/h1>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\n\n\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t\n\n\n\n<section style=\"background:#eeeeee\" class=\"wp-block-isd-layout has-background\"><div class=\"isd-background-fixed-max-width-container\"><div class=\"isd-layout-content-wrapper\" style=\"max-width:1748px;margin-bottom:0rem;margin-top:0rem;padding-bottom:3.75rem;padding-top:3.75rem\">\n<div class=\"wp-block-isd-row large-100 desktop-none desktop-order-1 tablet-none tablet-order-1 mobile-none mobile-order-1 frontend ctnrQueryRow\" style=\"margin-bottom:0rem;margin-top:0rem\">\n<div class=\"wp-block-isd-column\">\n<h2 class=\"wp-block-heading has-primary-color has-text-color\">Consumer Forms<\/h2>\n\n\n\n<p><strong>For questions on any of these forms or for assistance in completing them, call (909) 386-8256.<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading has-primary-color has-text-color\">Click on the name or + sign to expand any form you wish to learn more about<\/h4>\n\n\n\n<div id=\"_ccfd40-dd\" class=\"wp-block-isd-accordion\"><div class=\"accordion-inner-wrapper\">\n<div class=\"wp-block-isd-accordion-pane card\"><div class=\"accordion-trigger-wrapper \" id=\"heading-_a41cf6-03\"><button class=\"btn btn-link accordion-trigger icon-right iconStyle-basic\" data-bs-toggle=\"collapse\" data-bs-target=\"#_a41cf6-03\"><span class=\"isd-blocks-accordion-title\">Change of Provider Request<\/span><span class=\"fas\"><\/span><\/button><\/div><div id=\"_a41cf6-03\" class=\"collapse\" aria-labelledby=\"heading-_a41cf6-03\" data-parent=\"#_ccfd40-dd\"><div class=\"card-body\">\n<p>As a DBH consumer, you have the right to request a change if you are not satisfied with your current service provider. Requesting a change of provider does not put you at risk of being denied behavioral health services or having the type of services you received changed. Please fill out the form and turn it into the receptionist at the clinic where you are currently receiving services:<\/p>\n\n\n\n<p><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/Change%20of%20Provider%20Request%20%28QM047_E%29.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Change of Provider Request Form<\/a>\/ <a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/Change%20of%20Provider%20Request%20%28Spanish%29%28QM047_S%29.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Formulario para Solicitar el Cambio de Proveedor<\/a><\/p>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-isd-accordion-pane card\"><div class=\"accordion-trigger-wrapper \" id=\"heading-_57dc2b-68\"><button class=\"btn btn-link accordion-trigger icon-right iconStyle-basic\" data-bs-toggle=\"collapse\" data-bs-target=\"#_57dc2b-68\"><span class=\"isd-blocks-accordion-title\">Grievance Process<\/span><span class=\"fas\"><\/span><\/button><\/div><div id=\"_57dc2b-68\" class=\"collapse\" aria-labelledby=\"heading-_57dc2b-68\" data-parent=\"#_ccfd40-dd\"><div class=\"card-body\">\n<p>Access Unit-<br \/><br \/>A grievance is an oral or written expression of your dissatisfaction about any matter other than an Adverse Benefit Determination (see the Appeal Process section for more information). You have the right to make a grievance about any aspect of your treatment at a clinic or by a Medi-Cal Fee-For-Service Provider (private psychiatrist, psychologist, LCSW, or LMFT). You may make a grievance verbally or in writing. Grievance forms are available below or in provider\/clinic lobbies. Grievances will be processed within 90 Calendar days, with the option of a 14-calendar day extension if extending the deadline will be in your best interest. For questions, call 1 (888) 743-<a>1478<\/a>.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<p><a href=\"https:\/\/wp.sbcounty.gov\/dbh\/wp-content\/uploads\/sites\/121\/COM0953-1_ACA-1557-Grievance-Procedure_Final.pdf\">ACA Grievance Procedure &#8211; ENG<\/a><br \/><a href=\"https:\/\/wp.sbcounty.gov\/dbh\/wp-content\/uploads\/sites\/121\/COM038_E-ACA-1557-Grievance-Form_TRI_Update_6.22.21_OEI.pdf\">ACA Grievance Form &#8211; ENG<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/QM050_E%20Grievance%20Form.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Grievance Form<\/a>\/<a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/QM050_S-1%20Grievance%20Form%20Spanish.pdf\"> Formulario de Quejas<\/a><\/p>\n\n\n\n<p>Mail the form:<br \/>DBH Access &amp; Referral<br \/>303 E. Vanderbilt Way<br \/>San Bernardino, CA 92415<\/p>\n\n\n\n<p>Grievance Posters<br \/><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/Grievance%20Poster.docx\">English<\/a><br \/><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/Grievance%20Poster_Chinese.docx\">Chinese<\/a><br \/><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/Grievance%20Poster_Vietnamese.docx\">Vietnamese<\/a><br \/><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/Grievance%20Spanish%20Poster.docx\">Spanish<\/a><br \/><br \/>Patients&#8217; Rights-<br \/><br \/>A grievance is an oral or written expression of your dissatisfaction to inpatient and outpatient patients\u2019 rights matters as referenced in the Patients\u2019 Rights&nbsp;<a href=\"https:\/\/www.dhcs.ca.gov\/services\/Pages\/Office-of-Patients-Rights.aspx\"><strong>posters<\/strong><\/a>. Patients can submit a grievance over the phone or in writing.<\/p>\n\n\n\n<p>To submit a verbal Patients\u2019 Rights grievance, call (800) 440-2391. To submit a written Patients\u2019 Rights grievance, complete a Patients\u2019 Rights Grievance form located in a provider or clinic lobby or download the form <strong><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/PR001_E%20Patients%27%20RIghts%20Grievance%20Form%20and%20Spanish.pdf\">here<\/a><\/strong>, and mail OR email the completed form to:<\/p>\n\n\n\n<p>Patients\u2019 Rights Office<br \/>850 E. Foothill Blvd.<br \/>Rialto, CA 92376<\/p>\n\n\n\n<p><a href=\"mailto:DBHPatientRightsOffi@dbh.sbcounty.gov\">DBHPatientRightsOffi@dbh.sbcounty.gov<\/a><\/p>\n\n\n\n<p>Grievances will be addressed within 24 hours by phone or letter. For additional questions, call (909) 421-4657.<\/p>\n\n\n\n\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-isd-accordion-pane card\"><div class=\"accordion-trigger-wrapper \" id=\"heading-_7f9b7f-18\"><button class=\"btn btn-link accordion-trigger icon-right iconStyle-basic\" data-bs-toggle=\"collapse\" data-bs-target=\"#_7f9b7f-18\"><span class=\"isd-blocks-accordion-title\">Appeal Process<\/span><span class=\"fas\"><\/span><\/button><\/div><div id=\"_7f9b7f-18\" class=\"collapse\" aria-labelledby=\"heading-_7f9b7f-18\" data-parent=\"#_ccfd40-dd\"><div class=\"card-body\">\n<p>You also have the right to appeal an Adverse Benefit Determination. An Adverse Benefit Determination is defined as the following actions taken by Department of Behavioral Health, contract agency, or Fee-For-Service Provider:<\/p>\n\n\n\n<ol style=\"list-style-type:1\" class=\"wp-block-list\">\n<li>Denial or limited authorization of requested service(s), including determinations based on the type or level of service(s), medical necessity, appropriateness, setting or effectiveness of a covered benefit;<\/li>\n\n\n\n<li>Reduction, suspension, or termination of a previously authorized service(s);<\/li>\n\n\n\n<li>Denial, in whole or in part, of payment for a service;<\/li>\n\n\n\n<li>Failure to provide services in a timely manner;<\/li>\n\n\n\n<li>Failure to act within the time frames for standard resolutions of Grievance and\/or Appeal;<\/li>\n\n\n\n<li>Denial of a client or potential clients\u2019 request to dispute financial liability.<\/li>\n<\/ol>\n\n\n\n<p><strong>Appeal Form <\/strong><\/p>\n\n\n\n<p>An appeal is an oral or written objection to an Adverse Benefit Determination requiring further consideration and review by Department of Behavioral Health.&nbsp; An appeal must be filed within sixty (60) calendar days from the date on the Notice of Adverse Benefit Determination. Action Appeal Forms are available below, in the waiting room of the clinic, or the Fee-For-Service Provider. Standard appeals are processed within 30 days, with the option of a 14-day extension if extending the deadline will be in your best interest. Expedited Action Appeals may be requested if you or your provider certifies that taking the time for a standard action appeal resolution could seriously jeopardize your life, health, or ability to attain, maintain, or regain maximum function. Expedited Appeals are processed within seventy-two (72) hours after the expedited appeal request is received. &nbsp;For questions call 1 (888)743-1478<\/p>\n\n\n\n<p><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/QM051_E%20Action%20Appeal%20Form.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Action Appeal Form<\/a> \/ <a href=\"https:\/\/wp.sbcounty.gov\/dbh\/wp-content\/uploads\/sites\/121\/2021\/04\/QM051_S.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Formulario de Acci\u03ccn de Apelaci\u03ccn<\/a><\/p>\n\n\n\n<p>Mail the form to:<br \/>DBH Access &amp; Referral<br \/>303 E. Vanderbilt Way<br \/>San Bernardino, CA 92415<\/p>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-isd-accordion-pane card\"><div class=\"accordion-trigger-wrapper \" id=\"heading-_414d46-df\"><button class=\"btn btn-link accordion-trigger icon-right iconStyle-basic\" data-bs-toggle=\"collapse\" data-bs-target=\"#_414d46-df\"><span class=\"isd-blocks-accordion-title\">Second Opinion Request<\/span><span class=\"fas\"><\/span><\/button><\/div><div id=\"_414d46-df\" class=\"collapse\" aria-labelledby=\"heading-_414d46-df\" data-parent=\"#_ccfd40-dd\"><div class=\"card-body\">\n<p>When requested, the Department of Behavioral Health will provide a second opinion by a licensed mental health professional within its network of care or will arrange for you to obtain a second opinion outside the DBH network when its providers determine that the medical necessity criteria have not been met and that the member is, therefore, not entitled to any specialty mental health services or drug M<a>edi-Cal<\/a>&nbsp;organized delivery system services.<\/p>\n\n\n\n<p><a id=\"_msocom_1\"><\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/QM048_E_Request_for_Second_Opinion_English_21-0820_ECC2_Final.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Request for Second Opinion Form<\/a> \/ <a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/QM048_S_Request_for_Second_Opinion_Spanish_21-0820_ECC_Final.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Petici\u00f3n de Una Segunda Opinion<\/a><\/p>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-isd-accordion-pane card\"><div class=\"accordion-trigger-wrapper \" id=\"heading-_708886-5d\"><button class=\"btn btn-link accordion-trigger icon-right iconStyle-basic\" data-bs-toggle=\"collapse\" data-bs-target=\"#_708886-5d\"><span class=\"isd-blocks-accordion-title\">State Fair Hearing Process<\/span><span class=\"fas\"><\/span><\/button><\/div><div id=\"_708886-5d\" class=\"collapse\" aria-labelledby=\"heading-_708886-5d\" data-parent=\"#_ccfd40-dd\"><div class=\"card-body\">\n<p>You may request a State Hearing verbally, as a written request or you may complete the online hearing request page after the exhaustion of the appeals process.<strong><\/strong><\/p>\n\n\n\n<p>By phone: Call 1-800-952-5253. If you cannot speak or hear well, please call TTY\/TDD 1-800-952-8349.<\/p>\n\n\n\n<p>In writing: California Department of Social Services&nbsp;<\/p>\n\n\n\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; State Hearing Division<\/p>\n\n\n\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; P.O. Box 944243, Mail Station 9-17-37<\/p>\n\n\n\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Sacramento, CA 94244-2430&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/p>\n\n\n\n<p>Electronically: You may request a State Hearing online. Please visit the California Department of Social Services\u2019 <a href=\"https:\/\/acms.dss.ca.gov\/acms\/login.request.do\">website<\/a> to complete the electronic form: <a href=\"https:\/\/www.cdss.ca.gov\/hearing-requests\">Hearing Request<\/a>. Please review the following brochure for more information on how to file a state fair hearing request: <a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/State%20Hearing%20Your_Hearing_Rights%202015.pdf\">State Hearing Rights<\/a><\/p>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-isd-accordion-pane card\"><div class=\"accordion-trigger-wrapper \" id=\"heading-_b33938-ce\"><button class=\"btn btn-link accordion-trigger icon-right iconStyle-basic\" data-bs-toggle=\"collapse\" data-bs-target=\"#_b33938-ce\"><span class=\"isd-blocks-accordion-title\">Notice of Adverse Benefits Determination &#8211; Rights<\/span><span class=\"fas\"><\/span><\/button><\/div><div id=\"_b33938-ce\" class=\"collapse\" aria-labelledby=\"heading-_b33938-ce\" data-parent=\"#_ccfd40-dd\"><div class=\"card-body\">\n<p>(<a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/QM024_E%20Your%20Rights%20%28NOABD%29%20%28Rev.%2010-23%29.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">ENGLISH<\/a> \/ <a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/QM024_S%20Your%20Rights%20%28NOABD%29%20%28Rev.%2010-23%29%20Spanish.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">SPANISH<\/a> \/ <a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/QM024_M%20Your%20Rights%20%28NOABD%29%20%28Mandarin%29%20%28Rev.%2010-23%29.pdf\">MANDARIN<\/a> \/ <a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/QM024_V%20Your%20Rights%20%28NOABD%29%20%28Rev.%2010-23%29%20Vietnamese.pdf\">VIETNAMESE<\/a>)<\/p>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-isd-accordion-pane card\"><div class=\"accordion-trigger-wrapper \" id=\"heading-_083820-4d\"><button class=\"btn btn-link accordion-trigger icon-right iconStyle-basic\" data-bs-toggle=\"collapse\" data-bs-target=\"#_083820-4d\"><span class=\"isd-blocks-accordion-title\">Notice of Appeal Resolution<\/span><span class=\"fas\"><\/span><\/button><\/div><div id=\"_083820-4d\" class=\"collapse\" aria-labelledby=\"heading-_083820-4d\" data-parent=\"#_ccfd40-dd\"><div class=\"card-body\">\n<p>(<a rel=\"noreferrer noopener\" href=\"https:\/\/wp.sbcounty.gov\/dbh\/wp-content\/uploads\/sites\/121\/2020\/06\/QM025_E-COVID-19-Your-Rights-Attachment-NAR.docx\" target=\"_blank\">ENGLISH<\/a> \/ <a rel=\"noreferrer noopener\" href=\"https:\/\/wp.sbcounty.gov\/dbh\/wp-content\/uploads\/sites\/121\/2021\/04\/QM025_S-COVID-19-Your-Rights-Attachment-NAR.doc\" target=\"_blank\">SPANISH<\/a>)<\/p>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-isd-accordion-pane card\"><div class=\"accordion-trigger-wrapper \" id=\"heading-_986216-c2\"><button class=\"btn btn-link accordion-trigger icon-right iconStyle-basic\" data-bs-toggle=\"collapse\" data-bs-target=\"#_986216-c2\"><span class=\"isd-blocks-accordion-title\">Notice of  Privacy Practices <\/span><span class=\"fas\"><\/span><\/button><\/div><div id=\"_986216-c2\" class=\"collapse\" aria-labelledby=\"heading-_986216-c2\" data-parent=\"#_ccfd40-dd\"><div class=\"card-body\">\n<p><a href=\"https:\/\/wp.sbcounty.gov\/dbh\/wp-content\/uploads\/sites\/121\/2016\/07\/QM050_E.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a>(<a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/COM004%20E%20Notice%20of%20Privacy%20Practices%20English.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">English<\/a> \/ <a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/COM004_S%20Notice%20of%20Privacy%20Practices%20Spanish.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Spanish<\/a>\/ <a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/COM004_V%20Notice%20of%20Privacy%20Practices%20Vietnamese.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Vietnamese<\/a> \/ <a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/COM004_M%20Notice%20of%20Privacy%20Practices%20Mandarin.pdf\">Mandarin<\/a>)<\/p>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-isd-accordion-pane card\"><div class=\"accordion-trigger-wrapper \" id=\"heading-_546e50-e3\"><button class=\"btn btn-link accordion-trigger icon-right iconStyle-basic\" data-bs-toggle=\"collapse\" data-bs-target=\"#_546e50-e3\"><span class=\"isd-blocks-accordion-title\">Advance Health Care Directives<\/span><span class=\"fas\"><\/span><\/button><\/div><div id=\"_546e50-e3\" class=\"collapse\" aria-labelledby=\"heading-_546e50-e3\" data-parent=\"#_ccfd40-dd\"><div class=\"card-body\">\n<p>You have the right to make healthcare decisions. You can plan now for your medical care needs if in the future you are unable to speak for yourself.<\/p>\n\n\n\n<p><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/COM028_your_right_to_make_decisions.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Advance Health Care Directive Brochure<\/a> \/<a href=\"https:\/\/wp.sbcounty.gov\/dbh\/wp-content\/uploads\/sites\/121\/2021\/04\/COM028_Your_right_to_make_decisions-spanish.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Directiva Anticipada de Cuidado de Salud<\/a>\/ <a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/11\/COM028_V%20Advance%20Directive%20Brochure.pdf\">Advance Directive Brochure Vietnamese<\/a><\/p>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-isd-accordion-pane card\"><div class=\"accordion-trigger-wrapper \" id=\"heading-_82dc9c-be\"><button class=\"btn btn-link accordion-trigger icon-right iconStyle-basic\" data-bs-toggle=\"collapse\" data-bs-target=\"#_82dc9c-be\"><span class=\"isd-blocks-accordion-title\">Recovery Based Engagement Support Team (RBEST)<\/span><span class=\"fas\"><\/span><\/button><\/div><div id=\"_82dc9c-be\" class=\"collapse\" aria-labelledby=\"heading-_82dc9c-be\" data-parent=\"#_ccfd40-dd\"><div class=\"card-body\">\n<p><a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/06\/RBEST%20AOT%20Referral%20Form_6.14.24.pdf\">RBEST AOT Referral Form<\/a>\/<a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/06\/RBEST%20AOT%20Referral%20Form_%206.14.24.%20Approved_Spanish.pdf\">RBEST AOT Referral Form Spanish<\/a>\/<a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/06\/RBEST%20AOT%20Referral%20Form_%206.14.24.%20Approved_ChineseSimplified.pdf\">RBEST AOT Referral Form Mandarin<\/a>\/<a href=\"https:\/\/wp.sbcounty.gov\/wp-content\/uploads\/sites\/121\/2024\/06\/RBEST%20AOT%20Referral%20Form_%206.14.24.%20Approved-Vietnamese.pdf\">RBEST AOT Referral Form Vietnamese<\/a><\/p>\n<\/div><\/div><\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"<p>Consumer Forms Consumer Forms For questions on any of these forms or for assistance in completing them, call (909) 386-8256. Click on the name or + sign to expand any<span class=\"ellipsis\">&#8230;<\/span><\/p>\n","protected":false},"author":49,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-14499","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/wp.sbcounty.gov\/dbh\/wp-json\/wp\/v2\/pages\/14499","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wp.sbcounty.gov\/dbh\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wp.sbcounty.gov\/dbh\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wp.sbcounty.gov\/dbh\/wp-json\/wp\/v2\/users\/49"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.sbcounty.gov\/dbh\/wp-json\/wp\/v2\/comments?post=14499"}],"version-history":[{"count":35,"href":"https:\/\/wp.sbcounty.gov\/dbh\/wp-json\/wp\/v2\/pages\/14499\/revisions"}],"predecessor-version":[{"id":78324,"href":"https:\/\/wp.sbcounty.gov\/dbh\/wp-json\/wp\/v2\/pages\/14499\/revisions\/78324"}],"wp:attachment":[{"href":"https:\/\/wp.sbcounty.gov\/dbh\/wp-json\/wp\/v2\/media?parent=14499"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}