Organizational Provider Public Documents

This page is utilized by Organizational Provider Staff to obtain forms, manuals and reports for the electronic health record, Cerner Community Behavioral Health.

SUDPOH

Name Description Date
* SUDPOH Appendix K.3 - Multiple Billing Override Certification Form DHCS 6700.pdf
For Use Until June 30 2018 2017-10-16
* SUDPOH Appendix I.2 - Serious Incident Report SIR 04 01 17.doc
For Use Until June 30 2018 2017-10-16
* SUDPOH Appendix I.3 - Serious Incident Report of Findings SIROF 04 01 17.doc
For Use Until June 30 2018 2017-10-16
* SUDPOH Appendix I.4 - Root Cause Analysis RCA WORKSHEET 1-1-11.doc
For Use Until June 30 2018 2017-10-16
* SUDPOH Appendix C.2 - Waitlist Tracking Log 4-1-17.docx
For Use Until June 30 2018 2017-10-16
* SUDPOH Appendix D.2 - Program Accessibility Assessment 9-14-17.xlsx
For Use Until June 30 2018 2017-10-16
* SUDPOH Appendix G.2 - Gift Card Approval Form 7-21-14.xlsx
For Use Until June 30 2018 2017-10-16
* SUDPOH Appendix I.1 - SUD Complaint Report Form 8-30-17.docx
For Use Until June 30 2018 2017-10-16
* Substance Use Disorder Provider Operations Handbook (pdf)
For Use Until June 30 2018 2017-10-10
* Substance Use Disorder Provider Operations Handbook - SUDPOH (pdf)
NEW - For Use After Jul 1 2018 2018-06-20
* Substance Use Disorder Provider Operations Updates Sept. 2017 (pdf)
For Use Until June 30 2018 2017-10-10

SUDURM

Name Description Date
* 00 - SUD Uniform Record Manual (pdf)
2018-06-05
* 01 - Uniform Record Manual (pdf)
2018-03-09
* 02 - Client File Order (pdf)
2018-03-09
* 03 - Section 1 Detail (pdf)
2018-02-01
* 04 - 101 Instruction DMC Tracking Form 04-12-17.pdf
2017-05-01
* 05 - 101 DMC Tracking Form (pdf)
2017-04-27
* 06 - 101a-placement-non medi-cal tracking.pdf
2017-05-01
* 07 - 102a Instruction QAR Initial Review Form 4-12-17.pdf
2017-05-01
* 08 - 102a QAR Initial Review Form (pdf)
2018-06-05
* 09 - 102b Instruction QAR Extention-Stay-Discharge Form 4-12-17.pdf
2017-05-01
* 10-102b SUD Extension QAR Review Form (pdf)
2018-06-05
* 12 - 103 Instruction Medi-Cal Eligibility Printout 4-12-17.pdf
2017-05-01
* 13 - 104a Instruction Supplement Minor Children 04-12-17.pdf
2018-01-24
* 14 - 104a Minor Children Form 04-12-17.pdf
2018-01-24
* 15a - 104b Instructions Brief ASAM Phone Screening 1-22-18.pdf
2018-01-24
* 15b - 104b Brief ASAM Phone Screening 1-22-18.pdf
2018-01-24
* 15c - 104b Form Fill Brief ASAM Phone Screening 01-22-18.docx
2018-01-24
* 16a -104c Instructions Intake Adult ASAM Screening 1-22-18.pdf
2018-01-24
* 16b - 104c Intake Adult ASAM Screening 1-22-18.pdf
2018-01-24
* 16c - 104c Form Fill Intake Adult ASAM Screening 01-22-18.docx
2018-01-24
* 17a - 104d Instructions Intake Adolescent ASAM Screening 1-22-18.pdf
2018-01-24
* 17b - 104d Intake Adolescent ASAM Screening 01-22-18.pdf
2018-01-24
* 17c - 104d Form Fill Intake Adolescent ASAM Screening 01-22-18.docx
2018-01-24
* 18a - 104e Instructions Intake Parent ASAM Screening 1-22-18.pdf
2018-01-24
* 18b - 104e Intake Parent ASAM Screening 1-22-18.pdf
2018-01-24
* 18c - 104e Form Fill Intake Parent ASAM Screening 01-22-18.docx
2018-01-24
* 21 - 105-placement-fee collection 4-12-17.pdf
2017-05-01
* 23 - 106-placement-ID-SS-cards 4-12-17.pdf
2017-05-01
* 25 - 107-placement-Medi Cal Card 4-12-17.pdf
2017-05-01
* 26 - 108 Instruction Financial Responsibility and Info Form 4-12-17.pdf
2017-05-01
* 27 - 108 Financial Responsibility and Information Form (pdf)
2017-04-27
* 27a - S109 Instruction CalOMS Profile rev 3-2017.pdf
2017-05-01
* 27b - S109A CalOMS Profile (pdf)
2017-04-27
* 27c - S109B CalOMS Profile Collateral Contacts (pdf)
2017-05-01
* 28 - S110 Instruction SanWITS Intake rev 3-2017.pdf
2017-05-01
* 28a - S110 SanWITS Intake (pdf)
2017-05-01
* 29 - S111 Instruction CalOMS Admission rev 3-2017.pdf
2017-05-01
* 29a - S111 CalOMS Admission 5-17.pdf
2017-05-23
* 30 - S112 Instruction CalOMS Annual Update 3-2017.pdf
2017-05-01
* 31 - S112 CalOMS Annual Update 5-17.pdf
2017-05-23
* 32 - Section 2 Detail 4-12-17.pdf
2017-05-01
* 33 - 201-placement-consent to release 4-12-17.pdf
2017-05-01
* 34 - 202-placement-Admissions Agreement-Consent to Treatment 4-12-17.pdf
2017-05-01
* 35 - 203 Instruction Client Personal Rights 8-30-17.pdf
2017-10-19
* 36 - 203 Client Personal Rights 8-29-17.pdf
2017-10-19
* 37 - 204 Instruction Title 22 Fair Hearing Rights 4-12-17.pdf
2017-04-27
* 38 - 204 Title 22 Fair Hearing Rights 4-12-17.pdf
2017-04-27
* 39 - 205-placement-Notice of Privacy-HIPAA 4-12-17.pdf
2017-05-01
* 40 - 206-placement-Consent to Follow up 4-12-17.pdf
2017-05-01
* 41 - 207-placement-Consent for photo-tv-video 4-12-17.pdf
2017-05-01
* 42 - 208 Instruction Coordination of Care 4-12-17.pdf
2017-05-01
* 43 - 208 Coordination of Physical Behavioral Health (pdf)
2017-05-01
* 44 - Form Fill - 208 Coordination of Physical Behavioral Health.doc
2017-05-01
* 45 - Section 3 Detail (pdf)
2018-03-09
* 46 - 301 Instruction Stay Review 4-12-17.pdf
2017-05-01
* 47 - 301 Stay Review Form 4-12-17.pdf
2017-05-01
* 47a - Form Fill - 301 Stay Review Form 4-12-17.docx
2017-05-01
* 48 - 302 Instruction Alcohol and Drug Hx 4-12-17.pdf
2017-05-01
* 50 - 302 Alcohol and Drug History Form 4-12-17.pdf
2017-05-01
* 51 - 303 Instruction ASI-YAI 4-12-17.pdf
2017-05-01
* 52 - 303 ASI Lite.pdf
2017-04-27
* 53 - 303a YAI.pdf
2017-05-01
* 54 - 304 Instruction Co-occurring Form 4-12-17.pdf
2017-05-01
* 55 - 304 Co-occurring Screening Form 4-12-17.pdf
2017-04-27
* 56 - Form Fill - 304 Co-occurring Screening Form 4-12-17.doc
2017-04-27
* 57 - 305a Instruction HRA (pdf)
2018-02-01
* 58 - 305a High Risk Assessment 4-12-17.pdf
2017-05-01
* 59 - Form Fill - 305a High Risk Assessment 4-12-17.docx
2017-05-01
* 60 - 305b Instruction HRI 4-12-17.pdf
2017-05-01
* 61 - 305b High Risk Index 4-12-17.pdf
2017-05-01
* 62 - Form Fill - 305b High Risk Index 4-12-17.docx
2017-05-01
* 62a - 306 Instructions ASAM LOC Recomendation (pdf)
2018-03-09
* 62b - 306 ASAM LOC Recommendation (pdf)
2018-03-09
* 62c - 306 Form Fill ASAM LOC Recommendation (docx)
2018-03-09
* 63 - Section 4 Detail.pdf
2017-05-01
* 64 - 401 Instruction Client 12-hr Intensive Observation Log Detox 4-12-17.pdf
2017-05-01
* 65 - 401 12 Hours Observation Log-Detox.pdf
2017-04-27
* 66 - 402 Instruction Centrally Stored Medication & Destruction Record 4-12-17.pdf
2017-05-01
* 67 - 402 Centrally Stored Medication and Destruction Record.pdf
2017-04-27
* 68 - 403 Instruction Health Questionnaire Form 4-12-17.pdf
2017-05-01
* 69 - 403 Health questionnaire 4-12-17.pdf
2017-05-01
* 69a - 403 - Form Fill Health Questionnaire.pdf
2017-05-01
* 70 - 404 Instruction TB questionnaire 4-12-17.pdf
2017-05-01
* 71 - 404 TB screening form 4-12-17.pdf
2017-05-01
* 74 - 406 Instruction Physician Direction form 4-12-17.pdf
2017-05-01
* 75 - 406 Physician Direction Form 4-12-17.pdf
2017-05-01
* 76 - 407 MD Recomendation to client 4-12-17.pdf
2017-05-01
* 78 - 408-placement-proof of pregnancy 4-12-17.pdf
2017-05-01
* 79 - 409 Instruction Diagnosis Determination Note 4-20-17.pdf
2017-05-01
* 80 - 409 Diagnosis Determination Note (pdf)
2017-04-27
* 80a - Form Fill - 409 Diagnosis Determination Note (docx)
2017-05-10
* 81 - Section 5 Detail (pdf)
2018-03-09
* 82a - 501 Instructions Inital Treatment Plan (pdf)
2018-03-09
* 82b - 501 Initial Treatment Plan (pdf)
2018-03-09
* 82c - 501 Form Fill Initial Treatment Plan (docx)
2018-03-09
* 83 - 501 Treatment Plan 4-12-17.pdf
2017-05-01
* 83a - 502 Instructions Updated Treatment Plan (pdf)
2018-03-09
* 83b - 502 Updated Treatment Plan (pdf)
2018-03-09
* 83c - 502 Form Fill Updated Treatment Plan (docx)
2018-03-09
* 84a - 503 Instructions Addendum Treatment Plan (pdf)
2018-03-09
* 84b - 503 Addendum Treatment Plan (pdf)
2018-03-09
* 84c - 503 Form Fill Addendum Treatment Plan (docx)
2018-03-09
* 85 - Section 6 Detail.pdf
2017-05-01
* 86 - 601a b Instruction Progress Note 5-23-17.pdf
2017-05-30
* 87 - 601a Progress Notes 4-12-17.pdf
2017-04-27
* 87a - Form Fill - 601a Progress Notes 5-8-17.docx
2017-05-10
* 88 - 601b Weekly Progress Notes 4-12-17.pdf
2017-04-27
* 88a - 601b - Form Fill - Weekly Progress Notes 4-12-17.docx
2017-05-10
* 89 - Section 7 Detail.pdf
2017-05-01
* 90 - 701 Instruction Discharge Summary 4-12-17.pdf
2017-05-01
* 91 - 701 Discharge Summary Form 4-12-17.pdf
2017-04-27
* 91a-79-Form Fill - Discharge Summary 5-19-17.docx
2017-05-22
* 92 - 702 Instruction 10 Day Letter to Client 4-12-17.pdf
2017-05-01
* 93 - 702 10 Day Letter to Client 4-12-17.pdf
2017-04-27
* 94 - S703 Instruction CalOMS Discharge 3-2017.pdf
2017-05-01
* 95 - S703 CalOMS Discharge 5-17.pdf
2017-05-23
* 96 - 704 Instruction Client Discharge Plan 4-12-17.pdf
2017-05-01
* 97 - 704 Client Discharge Plan 4-12-17.pdf
2017-04-27
* 97a - 704 Form Fill Client Discharge Plan 4-12-17.docx
2017-05-01
* 98 - Section 8 Detail 4-12-17.pdf
2017-05-01
* 99 - 801 Instruction Drug Test and Results Log.pdf
2017-05-01
* 99a - 801 Drug Test and Result Log Form.pdf
2017-05-01
* 99b - 802 placement Drug Test Results From Lab 4-12-17.pdf
2017-05-01
* 99c - 803 placement Progress Reports.pdf
2017-05-01
* 99d - 804 placement Case Management Notes-Plans.pdf
2017-05-01
* 99e - 805 placement Referral Source Documents.pdf
2017-05-01
* Uniform Record Manual (pdf)
2017-05-01

Beneficiary

Name Description Date
* Advance Directive English.pdf
2015-10-09
* Advance Directive Spanish.pdf
2015-10-09
* 055 - OPOH - Appendix D - A.D.20 -TBS Brochure English 2015.pdf
2017-03-23
* Advance Directive Farsi.pdf
2018-02-28
* NOABD Authorization Delay Notice 04-15-18.doc
* NOABD Delivery System Notice Rv 04-15-18.doc
* NOABD Financial Liability Notice Rv 04-15-18.doc
* NOABD Grievance and Appeal Timely Resolution Notice 04-15-18.doc
* NOABD Language Assistance Notice Rv 04-15-18.pdf
2018-05-04
* NOABD Modification Notice Rv 04-15-18.doc
* NOABD Payment Denial Notice Rv 04-15-18.docx
2018-05-04
* NOABD Table Rv 4-01-18.pdf
2018-05-04
* NOABD Termination Notice Rv 04-15-18.doc
* NOABD Your Rights Notice 04-15-18.pdf
2018-05-04
* NAR Adverse Benefit Determination Upheld Notice 04-15-18.doc
* NOABD Beneficiary Non-Discrimination Notice Rv 04-15-18.pdf
2018-05-09
* NOABD Timely Access Notice Rv 04-15-18.doc
* NAR Your Rights State Hearing Rv 04-15-18.pdf
2018-06-18
* 12.NAR Adverse Benefit Determination Overturned Notice
* Advance Directive Arabic.pdf
2016-07-13
* Advance Directive Tagalog.pdf
2016-07-13
* Advance Directive Vietnamese.pdf
2016-07-13
* Beneficiary Materials Order Form (pdf)
2018-04-06
* Full Guide Farsi (pdf)
2018-05-18
* FullGuide Arabic 2013.pdf
2016-07-13
* FullGuide English.pdf
2016-07-13
* FullGuide Spanish 2013.pdf
2016-07-13
* FullGuide Tagalog 2013.pdf
2016-07-13
* FullGuide Vietnamese 2013.pdf
2016-07-13
* Grievance-Appeal Brochure Arabic (pdf)
2017-11-27
* Grievance-Appeal Brochure English (pdf)
2017-11-27
* Grievance-Appeal Brochure Farsi (pdf)
2018-02-28
* Grievance-Appeal Brochure Spanish (pdf)
2017-11-27
* Grievance-Appeal Brochure Tagalog (pdf)
2017-11-27
* Grievance-Appeal Brochure Vietnamese (pdf)
2017-11-27
* Grievance and Appeal Form --CCHEA OP Advocacy 1 15 16 TAG.docx
2016-04-01
* Grievance and Appeal Form - CCHEA Advocacy 12 20 17 FARSI.docx
2017-12-22
* Grievance and Appeal Form - CCHEA OP Advocacy 1 15 16.docx
2016-07-13
* Grievance and Appeal Form - CCHEA OP Advocacy 1 15 16 AR.docx
2016-07-13
* Grievance and Appeal Form - CCHEA OP Advocacy 1 15 16 ES.docx
2016-07-13
* Grievance and Appeal Form - CCHEA OP Advocacy 1 15 16 Viet.docx
2016-07-13
* Grievance and Appeal Form - JFS Advocacy 12-20-17 FARSI.docx
2017-12-22
* Grievance and Appeal Form - JFS Advocacy 1 15 16.docx
2016-07-13
* Grievance and Appeal Form - JFS Advocacy 1 15 16 AR.docx
2016-07-13
* Grievance and Appeal Form - JFS Advocacy 1 15 16 ES.docx
2016-07-13
* Grievance and Appeal Form - JFS Advocacy 1 15 16 Viet.docx
2016-07-13
* LimitedEnglishProficiencyPoster Farsi (pdf)
2018-05-18
* LimitedEnglishProficiencyPoster Arabic 03-17-05.pdf
2016-07-13
* LimitedEnglishProficiencyPoster English.pdf
2016-07-13
* LimitedEnglishProficiencyPoster Spanish.pdf
2016-07-13
* LimitedEnglishProficiencyPoster Tagalog.pdf
2016-07-13
* LimitedEnglishProficiencyPoster Vietnamese.pdf
2016-07-13
* NPP Acknowledgement - Farsi (pdf)
2018-02-13
* NPP Acknowledgement Arabic 2016.docx
2016-07-13
* NPP Acknowledgement English 2016.docx
2016-07-13
* NPP Acknowledgement Spanish 2016.docx
2016-07-13
* NPP Acknowledgement Tagalog 2016.docx
2016-07-13
* NPP Acknowledgement Vietnamese 2016.docx
2016-07-13
* Notice of Privacy Practices - Farsi (pdf)
2018-02-13
* NoticeofPrivacyPractices Arabic 12-16-14.pdf
2017-02-06
* NoticeofPrivacyPractices English 12-16-14.pdf
2017-02-06
* NoticeofPrivacyPractices Spanish 12-16-14.pdf
2017-02-06
* NoticeofPrivacyPractices Tagalog 12-16-14.pdf
2017-02-06
* NoticeofPrivacyPractices Vietnamese 12-16-14.pdf
2017-02-06
* Physician Notice To Patients California Regulation.pdf
2016-07-13
* Recovery Brochure English 8-5-13.pdf
2016-07-13
* Recovery Brochure Spanish 09-11rev.pdf
2016-07-13
* SD Grievance-Appeal POSTER Arabic (pdf)
2018-01-19
* SD Grievance-Appeal POSTER English (pdf)
2018-01-19
* SD Grievance-Appeal POSTER English LARGE FONT (pdf)
2018-01-19
* SD Grievance-Appeal POSTER Farsi (pdf)
2018-01-19
* SD Grievance-Appeal POSTER Spanish (pdf)
2018-01-19
* SD Grievance-Appeal POSTER Tagalog (pdf)
2018-01-19
* SD Grievance-Appeal POSTER Vietnamese (pdf)
2018-01-19

Communications

Name Description Date
* FAQ - Request for Servcies Log - Access Time Report - 9-30-14 .pdf
2016-07-15
* QI MIS MEMO 2014 1 09 Notifications in Anasazi.pdf
2016-05-16
* QM Memo - 90 Day Lockout Process Update 11 06 13.pdf
2015-10-09
* QM MEMO - Documentation Guidelines when EHR Unavailable 9 04 14.docx
2015-10-09
* QM MEMO - New Interactive Add On Service Code 785 9 22 14.docx
2015-10-09
* QM MEMO - Reaffirming DHCS Day Treatment Standards 08 26 14.docx
2015-10-09
* QM MEMO DHP 4 14.pdf
2015-10-09
* QI MIS MEMO 2015 11 20 Saving Reports to a SpreadsheetProcess and Policy.pdf
2015-11-30
* QM MEMO - Day Tx Program - Updated Standards.5.1.16.docx
2016-05-11
* QI MIS MEMO 2016 05 09 CCBH Outside of the Office Update.pdf
2016-05-11
* QM MEMO - ICD Code Updates 9 30 16.docx
2016-10-03
* QI MIS MEMO 2016 10 31 CCBH Demographic Form Table Change.docx
2016-11-03
* QI MIS MEMO 2016 12 01 CCBH Client Attachments.pdf
2018-05-25
* QM MEMO - 42 CFR Final Rule 1-26-17.pdf
2017-02-02
* QM MEMO - Place of Service Update 03 30 17.pdf
2017-03-31
* QM MEMO - Day Treatment Interim Folder 03 29 17.pdf
2017-03-31
* QM MEMO - Allowed Services Prior to Client Plan Completion - DHCS Guidelines 6 20 17.pdf
2017-06-21
* QM MEMO - New Evidence Based Practice Indicators 06 23 17.pdf
2017-06-27
* QM MEMO - Utilization of BHA Adult Walk In for OP Walk In Services 6 21 17.pdf
2017-06-27
* QM MEMO - Client Plan Redesign 6-20-17.pdf
2017-06-27
* QM MEMO - New Auth to Use-Disclose Multiple Form 051513.pdf
2017-05-12
* CSI Requirement for MH Programs 08 27 12 (pdf)
2016-07-15
* OPTUMIST Newsletter Fall 2017 (pdf)
2018-06-15
* QI MIS MEMO CCBH Access to Services Journal (pdf)
2018-06-15
* QI PIT MEMO 2018 6-1-18 AOA Substance Use Tracking Reporting Changes (pdf)
2018-06-14
* QM MEMO - Controlled Substance - CURES Mandate (pdf)
2018-06-08
* QM Memo - CPT Coding Changes 2013 (pdf)
2016-07-15
* QM Memo - Holder of Records 01 03 13 (pdf)
2016-07-15
* QM Memo - LPCC Credential Under MHP 07 24 13 (doc)
2015-10-09
* QM Memo - New Billing Indicators - Intrepreter and Language 06-08-17 (pdf)
2017-06-14

Forms

Name Description Date
* Day Treatment Weekly Summary Rv 9 01 14.doc
2015-10-09
* Interpreter Authorization form-fill Feb 2015.doc
2016-07-13
* SERIOUS INCIDENT RCA WORKSHEET 1-1-11.doc
2015-11-05
* Medication Monitoring Screening Tool - Child Adolescent-04-01-16.doc
2016-05-18
* Request for Services Log - Access Times Report - 7-1-16 protected.xlsx
2016-05-23
* MRR Tool FY16-17 FINAL Rv 07 11 16.pdf
2016-08-09
* Med Mon McFloop form - 6 30 11.docx
2016-11-15
* Med Mon Screening Tool - Adult - 7-1-13.doc
2016-11-15
* Privacy Incident Report 2014.docx
2016-11-29
* 035 - OPOH - Appendix D - A.D.01 - 72-Hour Post Discharge Log - 03-23-16.pdf
2017-03-23
* 046 - OPOH - Appendix D - A.D.12 - Case Management URC Minutes - Rev 7-14-09 - CC.pdf
2017-03-23
* BHS Serious Incident Report FINAL 04 01 17.doc
2017-04-19
* BHS Serious Incident Report of Findings FINAL 04 01 17.doc
2017-04-19
* Individual Service Record.doc
2017-07-11
* 114 - OPOH - Appendix N - A.N.2 Service Record - 1-1-12.pdf
2017-08-24
* REFERRAL TO PRIMARY CARE FARSI.pdf
2017-09-14
* REFERRAL TO PRIMARY CARE FORM FILL FARSI.docx
2017-09-14
* Privacy Incident Report 2017.docx
2017-11-03
* jv220b.pdf
2018-03-01
* jv220a.pdf
2018-03-01
* BHS-025 Form A Template 05-06-2014-form fill.doc
2016-07-15
* BHS-025 Form B Template 05-06-2014-form fill.doc
2016-07-15
* BHS-025 Instructions for completing Forms A-B updated 05-06-2014.doc
2015-10-09
* 5150 Form (pdf)
2018-06-20
* California Brief Multicultural Competence Scale CBMCS (pdf)
2016-07-13
* Case Management Six Month Review Progress Note (pdf)
2017-03-23
* Case Management UR Record (pdf)
2017-03-23
* Cultural Competency Program Annual Self Evaluation (pdf)
2016-07-13
* DPC 203 Contractor (xlsx)
2018-06-20
* DPC 203 Mobile Devices (xls)
2018-06-20
* DPC 203 Mobile Devices SUPPLEMENTAL 2017 (xls)
2018-06-20
* DPC 203 Mobile Devices SUPPLEMENTAL.xls
2017-03-09
* Day Program Attendance Log 9-01-14.xls
2016-11-29
* Exhibit C.xlsx
2017-03-09
* Group Service Record (rtf)
2017-07-11
* Med Mon Submission Form - Adult (pdf)
2018-06-08
* Med Mon Submission Form - CYF (pdf)
2018-06-08
* Med Monitoring Submission Form – Adult (xlsx)
2018-06-20
* Med Monitoring Submission Form – Children’s (xlsx)
2018-06-20
* Med Monitoring Tool AOA (pdf)
2018-06-08
* Med Monitoring Tool AOA (docx)
2018-06-20
* Med Monitoring Tool CYF (docx)
2018-06-20
* Med Monitoring Tool CYF (pdf)
2018-06-08
* Med Mon Submission Form - Adult - 7-1-13.xlsx
2016-11-15
* Medi-Cal Administrative Activities (MAA) Procedures
2017-08-24
* Medi-Cal Cert - Recent Site Review Tool - FY 13 14 - Rev 7 17 13.xls
2016-07-13
* Medication Monitoring Submission Form - Childrens-04-01-16.xlsx
2016-07-13
* NVRA Voter Preference Form Farsi.pdf
2017-09-14
* NVRA Voter Preference Form Fill Farsi- .docx
2017-09-14
* OP UR Committee Minutes (1) (pdf)
2017-03-23
* OP UR Minutes (2) (pdf)
2017-03-23
* QI MIS MEMO 2017 3 3 CCBH Signature Pads and Available Forms.docx
2017-03-15
* REFERRAL TO PRIMARY CARE FORM – ENGLISH (pdf)
2016-07-13
* Request for Verification of Veterans Eligibility (pdf)
2017-03-23
* START TCC and URC Record (pdf)
2017-03-23
* START URC Minutes Form (pdf)
2017-03-23
* San Bernardino County Department of Behavioral Health
2017-03-23
* TBS Referral Form Fill (pdf)
2017-03-23
* UM Treatment Justification for On-going Services (pdf)
2017-03-23
* Utilization Review Committee Form (pdf)
2017-03-23

Manuals

OPOH

Name Description Date
* 093 -7 - OPOH - Appendix G - A.G1.23 - Privacy Incident Report 2014.pdf
2016-07-13
* 097 - OPOH - Appendix I - Management Information System - Coversheet.pdf
2016-07-13
* 101 - OPOH - Appendix J - Provider Contracting - Coversheet .pdf
2016-07-13
* 102 - OPOH - Appendix J - A.J.1 - BHS Inventory Form 2010.pdf
2016-07-13
* 105 - OPOH - Appendix K - A.K.1 - Formal Complaint by Provider Form.pdf
2016-07-13
* 106 - OPOH - Appendix K - A.K.2 - Formal Response To Complaint Form.pdf
2016-07-13
* 107 - OPOH - Appendix K - A.K.3 - Formal Appeal by Provider Form .pdf
2016-07-13
* 108 - OPOH - Appendix K - A.K.4 - Formal Appeal Response Form .pdf
2016-07-13
* 109 - 00 - OPOH - Appendix L - Practice Guidelines - Coversheet.pdf
2016-07-13
* 109 - 01 - OPOH - Appendix L - A.L.1 - Monitoring Psychtropic Medications - 7-16-12.pdf
2016-07-13
* 110 - OPOH - Appendix M - Staff Qualifications and Supervision - Coversheet.pdf
2016-07-13
* 111 - OPOH - Appendix M - A.M.1 - License Waiver Form 6.15.10.pdf
2016-07-13
* 112 - OPOH - Appendix N - Data Requirements.pdf
2016-07-13
* 113 - OPOH - Appendix N - A.N.1 - MAA Procedures - 1-1-12 - rev 2-13-12.pdf
2016-07-13
* 114 - OPOH - Appendix N - A.N.2 Service Record - 1-1-12.pdf
2016-07-13
* 115 - OPOH - Appendix O - Training-Technical Assistance - Coversheet.pdf
2016-07-13
* 116 - OPOH - Appendix P - Mental Health Services Act - Coversheet.pdf
2016-07-13
* 117 - OPOH - Appendix Q - Payment Schedule and Budget Guidelines for Contract Only - Coversheet.pdf
2016-07-13
* 118 - OPOH - Appendix R - Quick Reference Guide.pdf
2016-07-13
* 008 - OPOH - Section E - Integration With Physical Healthcare -12-16-13.pdf
2016-07-13
* 014 - OPOH - Section K - Provider Issue Resolution - 9-6-12.pdf
2016-07-13
* 015 - OPOH - Section L - Practice Guidelines - 10-18-12.pdf
2016-07-13
* 026 - OPOH - Appendix B - Compliance and Confidentiality - Cover Sheet .pdf
2016-07-13
* 027-02 OPOH - Appendix B - A.B.2 - Privacy Incident Process September 2014 Program.pdf
2016-07-13
* 027-03 OPOH - Appendix B - A.B.3 - Privacy Incident Report 2014.pdf
2016-07-13
* 028 - OPOH - Appendix C - Accessing Services - Cover Sheet.pdf
2016-07-13
* 030 - OPOH - Appendix C - A.C.2 - AMHS - Walk-in Clinics Hours Contacts - 04-14-14.pdf
2016-07-13
* 031 - OPOH - Appendix C - A.C.3 - Transition Age Youth Referral Form -4-15-14.pdf
2016-07-13
* 032 - OPOH - Appendix C - A.C.4 - Transtion Age Youth Referral Plan 4-15-14.pdf
2016-07-13
* 033 - OPOH - Appendix C - A.C.5 - Reestablishment Recommendation Form.pdf
2016-07-13
* 034 - OPOH - Appendix D - Providing Specialty Mental Health Services - Cover Sheet .pdf
2016-07-13
* 055 - OPOH - Appendix E - Interface With Physical Health Care - Coversheet .pdf
2016-07-13
* 056 - OPOH - Appendix E - A.E.1 - FINAL Coordination of Care Form English.pdf
2016-07-13
* 057 - OPOH - Appendix E - A.E.2 - HSDPlanPartnerCard.pdf
2016-07-13
* 058 - 00 - OPOH - Appendix E - A.E.3 - Plan Partner Identification for Pharmacies.pdf
2016-07-13
* 058 - 01 - OPOH - Appendix E - A.E.4 - FINAL Coordination of Care Form Arabic.pdf
2016-07-13
* 058 - 02 - OPOH - Appendix E - A.E.5 - FINAL Coordination of Care Form Spanish.pdf
2016-07-13
* 058 - 03 - OPOH - Appendix E - A.E.6 - FINAL Coordination of Care Form Tagalog.pdf
2016-07-13
* 058 - 04 - OPOH - Appendix E - A.E.7 - FINAL Coordination of Care Form Viet.pdf
2016-07-13
* 059 - OPOH - Appendix F - Beneficiary Rights Issue Resolution - Coversheet.pdf
2016-07-13
* 076 - OPOH - Appendix G - Quality Improvement Program - Coversheet .pdf
2016-07-13
* 079 - OPOH - Appendix G - A.G.03 - Med Mon Screening Tool - Adult - 7-1-13.pdf
2016-07-13
* 082 - OPOH - Appendix G - A.G.06 - Med Mon McFloop form - 6 30 11.pdf
2016-07-13
* 083 - OPOH - Appendix G - A.G.07 - AMH Quarterly Status Report - 01-12.pdf
2016-07-13
* 084 - OPOH - Appendix G - A.G.08 - CMH Quarterly Status Report - 9-15-11.pdf
2016-07-13
* 088 - OPOH - Appendix G - A.G.11 - SERIOUS INCIDENT ROOT CAUSE ANALYSIS WORKSHEET.pdf
2016-07-13
* 089 - OPOH - Appendix G - A.G.12 - RCA WORKSHEET Sample 2.pdf
2016-07-13
* 090 - OPOH - Appendix G - A.G.13 - Med Mon Submission Form - Adult - 7-1-13.pdf
2016-07-13
* 092 - OPOH - Appendix G - A.G.15 - Perpetual Inventory Medication Log - Rev. 2 29 06.pdf
2016-07-13
* 093 - 0 - OPOH - Appendix G - A.G.16 - Medication Disposal Log - Rev. 3 1 06.pdf
2016-07-13
* 093 - 2 - OPOH - Appendix G - A.G.18 - NVRA Voter Preference Form - Arabic.pdf
2016-07-13
* 093 - 3 - OPOH - Appendix G - A.G.19 - NVRA Voter Preference Form - English.pdf
2016-07-13
* 093 - 4 - OPOH - Appendix G - A.G.20 - NVRA Voter Preference Form - Spanish.pdf
2016-07-13
* 093 - 5 - OPOH - Appendix G - A.G.21 - NVRA Voter Preference Form - Tagalog.pdf
2016-07-13
* 093 - 6 - OPOH - Appendix G - A.G.22 - NVRA Voter Preference Form - Vietnamese.pdf
2016-07-13
* 033-1 - OPOH - Appendix C - A C 7 - Written Translation Service Authorization Form.pdf
2016-07-13
* 033-2 - OPOH - Appendix C - A C 8 - Service Authorization Request Form.pdf
2016-07-13
* 080 - OPOH - Appendix G - A.G.04 - Med Mon Screening Tool - Child Adolescent - 04-01-16.pdf
2016-04-15
* 091 - OPOH - Appendix G - A.G.14 - Med Mon Submission Form - Childrens-04-01-16.pdf
2016-04-15
* 093 - 1 - OPOH - Appendix G - A.G.17 - New Program Orientation-07-22-16.pdf
2016-08-16
* 018 - OPOH - Section O - Training-08-05-16.pdf
2016-08-18
* Appendix C - A.C.10 - Reestablishment Recommendation Form.doc
2016-11-29
* 027-01 OPOH - Appendix B - A.B.1 - Documentation Standards for Client Records.pdf
2016-11-29
* 078 - OPOH - Appendix G - A.G.02 - MRR Appeal Instructions - 10-31-14.pdf
2016-11-29
* 104 - OPOH - Appendix J - A.J.5 - DPC 203 Mobile Devices Exhibit C Pricing Sheet.pdf
2016-11-29
* 104 - OPOH - Appendix K - Provider Issue Resolution - Coversheet.pdf
2016-11-29
* 003 - OPOH - Customer Service Mission-11-30-16.pdf
2016-12-05
* 098 - OPOH - Appendix I - A.I.1 - Anasazi Request Form - 11-14-13.pdf
2017-01-09
* 099 - OPOH - Appendix I - A.I.2 - Summary of Policies - 07 01 08.pdf
2017-01-09
* 100 - OPOH - Appendix I - A.I.3 - E-Signature Agreement - Rev 050511.pdf
2017-01-09
* 033-0 - OPOH - Appendix C - A C 6 - Request for Services Access Times Log Manual 7-1-16.pdf
2017-03-09
* 029 - OPOH - Appendix C - A.C.1 - Request for Services Log - Access Times Report - 2-1-17.xlsx
2017-03-09
* 020 - OPOH - Section Q - Payment Schedule and Budget Guidelines for Cost Reimbursement Contract Only - 7-7-16.pdf
2017-03-09
* 010 - OPOH - Section G - Quality Improvement-04-20-17.pdf
2017-05-22
* 021 - OPOH - Section R - Quick Reference - 07-26-17.pdf
2017-08-09
* 017 - OPOH - Section N - Data Requirements -07-13-17.pdf
2017-08-09
* 04 - OPOH - Section A - Systems of Care - 08 29 17.pdf
2017-11-28
* 07 - OPOH - Section D - Providing Specialty Mental Health Services - 02 27 18.pdf
2018-02-28
* 01 - Cover Sheet Org Provider Manual 1 19 18.pdf
2018-02-28
* 06 - OPOH - Section C - Accessing Services - 02 20 18.pdf
2018-02-28
* 12 - OPOH - Section I - Management Info System - 02 26 18.pdf
2018-02-28
* 19 - OPOH - Section P - Mental Health Services Act 2-15-18.pdf
2018-02-28
* 05 - OPOH - Section B - Compliance Confidentiality - 03 01 18.pdf
2018-03-19
* 09- OPOH - Section F - Beneficiary Rights, Grievance and Appeals - 03-15-18.pdf
2018-03-19
* 02 - Table of Contents Org Prov Op Handbook -03-15-18.pdf
2018-03-19
* 07 - OPOH - Section D - Providing Specialty Mental Health Services 3.6.1....pdf
2018-05-09
* 10 - OPOH - Section G - Quality Improvement - 1.29.18.pdf
2018-05-09
* 11 - OPOH - Section H - Cultural Competency 01-16-18.pdf
2018-05-09
* 16 - OPOH - Section M - Staff Qualifications - 6.4.18.pdf
2018-06-08
* 15 - OPOH - Section L - Practice Guidelines - 6.07.18.pdf
2018-06-08
* 13 - OPOH - Section J - Provider Contracting - 6.5.18.pdf
2018-06-08

References

Name Description Date
* EPSDT TBS Brochure English.pdf
2016-07-15
* EPSDT TBS Brochure Spanish.pdf
2016-07-15
* ICD 10 and DAS FINAL 9-21-2015.pdf
2015-10-09
* NOA A-E Table.docx
2015-10-09
* Service Group Record 9-28-15.doc
2015-10-09
* State Plan Amendment SPA 12-025.pdf
2015-10-09
* County Webinar ICD-10-CM QandA Final 9-11-15.docx
2016-07-15
* ICD 10 and DAS Tip Sheet 09.2015.docx
2016-07-15
* Diagnosis Practice Guidelines Rv 03 01 16.pdf
2016-03-15
* New PM QI Orientation 09 07 2016.ppt
2016-09-09
* ICD-10 Crosswalk version 2.1 9.29.16 with V Codes.xlsx
2018-05-25
* Prof License Waiver Requirements DHCS.pdf
2016-10-07
* Abbreviation List - BHS Version Final 11 30 16.docx
2016-11-30
* CLINICAL STANDARD - Assessments in CCBH FINAL Rv 4 16 14.docx
2016-12-08
* New Program Orientation - QI Checklist Rev 12 15 16.pdf
2016-12-19
* Client Categories Maintenance 03 2017.pdf
2017-03-08
* 036 - OPOH - Appendix D - A.D.02 - Medical Necessity Criteria for MHP - Rev 7-14-09 .pdf
2017-03-23
* 037 - OPOH - Appendix D - A.D.03 - California State Penal Institutions List .pdf
2017-03-23
* 049 - OPOH - Appendix D - A D 15 - Outpatient Level of Care - 10-27-16.pdf
2017-03-23
* Intensive Service Request ISR CYF Memo 04-1617.pdf
2017-06-30
* QI UPDATES - Annual 7 11 17 FINAL.pdf
2017-07-13
* MRR Tool FY 2017-2018 Rev 7-18-17.xlsx
2017-08-15
* State Health Information Guidance - December 2017.pdf
2017-12-18
* ICD-10 Covered Diagnosis Table Outpatient SMHS.pdf
2018-01-09
* ICD-10 Crosswalk version 2.2 Rev 1.8.17 with V Codes.xlsx
2018-01-16
* Reasons for Recoupment FY2017 18.pdf
2018-01-19
* Program Provider Numbers List.pdf
2018-02-15
* Travel Time Guidelines Final 2-01-18.pdf
2018-02-15
* NOABD Table Rv 4-01-18.pdf
2018-05-01
* MIS-25 Program Listing Report.xlsx
2018-05-15
* CCBH Void Replace Reasons Rev 2 2018.xlsm
2018-05-18
* FAQs from CPT Changes 2013 Webinar (pdf)
2016-07-15
* Setting the Face Sheet to Display Instructions (doc)
2016-07-15
* 3rd Party Coverage Report Instructions (ppt)
2015-10-09
* 3rd Party Suspense Report Instructions (ppt)
2015-10-09
* CCBH - CP Folder and PN TIP SHEET-updated 6 16 17.pdf
2017-06-27
* CCBH - Quick Click Guide REVIEW - REVISE-updated 6 16 17.pdf
2017-06-27
* CCBH CP Quick Click Guide-updated 6 16 17.pdf
2017-06-27
* Client Management Payment Report V3.pdf
2016-07-15
* EM Coding Algorithm (pdf)
2016-07-15
* CPT Changes 2013 Presentation.pdf
2015-10-09
* CPT Codes New 2013.pdf
2015-10-09
* CPT 2013 Coding Changes FAQ.doc
2016-07-15
* EM 101 - CPT Coding Changes - 2013 (pdf)
2015-10-09
* Denial Report Instructions (ppt)
2015-10-09
* Expanded Medi-Cal - MH Severity Tool - 3.14.pdf
2016-07-15
* Expanded Medi-Cal - County of San Diego Definition of Mental Health Target Population and Scope of Services - 04-25-14.pdf
2015-10-09
* Expanded Medi-Cal - Severity Analysis Reference Guide For Adults - 4-25-14.pdf
2016-07-15
* Expanded Medi-Cal - Severity Analysis Reference Guide For Children Youth - 5-5-14.pdf
2016-07-15
* PWB Report Template Instructions (pdf)
2016-05-16
* Payment Appilication Claims Report Instructions (pdf)
2016-05-16
* CCBH Report Uses for Program Integrity (pdf)
2016-05-16
* Service Date Verification Report.pdf
2016-05-16
* Clinical Standard for Assessments (doc)
2018-06-15
* Clinical Standards for Client Plans (pdf)
2018-06-15
* EM 102 CPT Coding Changes - 2013 (pdf)
2015-10-09

UCRM

Name Description Date
* ACKNOWLEDGEMENT NPP.docx
2018-05-25
* ADVANCE DIRECTIVE ADVISEMENT.doc
2018-05-25
* ADVANCE DIRECTIVE ADVISEMENT EXPLANATION.docx
2018-05-25
* AIMS EXPLANATION.docx
2018-05-25
* AUTHORIZATION TO USE OR DISCLOSE PHI ARABIC.pdf
2017-02-17
* AUTHORIZATION TO USE OR DISCLOSE PHI CHILD 04-24A-C.dot
2017-02-17
* AUTHORIZATION TO USE OR DISCLOSE PHI ENGLISH.pdf
2017-02-17
* AUTHORIZATION TO USE OR DISCLOSE PHI SPANISH.pdf
2017-02-17
* AUTHORIZATION TO USE OR DISCLOSE PHI TAGALOG.pdf
2017-02-17
* AUTHORIZATION TO USE OR DISCLOSE PHI VIETNAMESE.pdf
2017-02-17
* BHA - ADULT PAPER FORM INSTRUCTIONS.docx
2018-05-25
* BHA - ADULT WALK IN FORM FILL.doc
2017-02-17
* BHA - CHILDREN PAPER FORM INSTRUCTIONS.docx
2018-05-25
* BHA - ESU FORMFILL.doc
2017-08-02
* BHA - ESU PAPER FORM INSTRUCTIONS.doc
2017-02-17
* BHA - TBS PAPER FORM INSTRUCTIONS.doc
2017-02-17
* CAMS EXPLANATION.docx
2018-05-25
* CAMS PARENT.pdf
2017-02-17
* CAMS YOUTH.pdf
2017-02-17
* CLIENT INFORMATION FACE SHEET EXPLANATION.docx
2018-05-25
* CLIENT PLAN SIGNATURE PAGE.docx
2018-05-25
* CONSENT FOR SERVICES.docx
2018-05-25
* CONSENT FOR SERVICES EXPLANATION.docx
2018-05-25
* COORDINATION OF CARE FORM.docx
2018-05-25
* COORDINATION OF CARE FORM EXPLANATION.docx
2018-05-25
* DAY PROGRAM REQUEST SMHS.doc
2017-02-17
* DAY TREATMENT CLIENT PLAN.doc
2017-02-17
* DAY TREATMENT WEEKLY SUMMARY.doc
2017-02-17
* DAY TREATMENT WEEKLY SUMMARY INSTRUCTIONS.docx
2018-05-25
* DEMOGRAPHIC FORM EXPLANTION.docx
2018-05-25
* INFORMED CONSENT PSYCHOTROPIC MEDS EXPLANATION.docx
2018-05-25
* INITIAL SCREENING ESU PAPER FORM INSTRUCTIONS.doc
2017-02-17
* INITIAL SCREENING EXPLANATION.docx
2018-05-25
* INITIAL SCREENING PAPER FORM INSTRUCTIONS.doc
2017-02-17
* ECBI EXPLANATION.docx
2018-05-25
* HIGH RISK ASSESSMENT EXPLANATION .docx
2018-05-25
* HIGH RISK ASSESSMENT FORM FILL.docx
2018-05-25
* HIGH RISK INDEX FORM FILL.docx
2018-05-25
* IMR CLINICIAN VERSION 072910.pdf
2018-05-25
* MY SAFETY PLAN FORM FILL VIETNAMESE.docx
2018-01-19
* LOCUS ADULT OUTCOMES TOOL.pdf
Image 2018-05-25
* MEDICAL CONDITION REVIEW EXPLANATION.docx
2018-05-25
* MEDICAL CONDITION REVIEW FORM EHR.docx
2018-05-25
* MORS ADULT OUTCOME MEASURE.docx
2018-05-25
* MY SAFETY PLAN EXPLANATION.docx
* MY SAFETY PLAN FORM FILL ARABIC.docx
2018-01-19
* MY SAFETY PLAN FORM FILL ENGLISH.docx
2018-01-19
* MY SAFETY PLAN FORM FILL SPANISH.docx
2018-01-19
* MY SAFETY PLAN FORM FILL TAGALOG.docx
2018-01-19
* PRESCRIPTIONS POWER OUTAGE INSTRUCTIONS.docx
* PSYCHIATRIC ASSESSMENT EHR EXPLANATION.docx
* PSYCHIATRIC ASSESSMENT PAPER FORM INSTRUCTIONS.doc
2017-02-17
* RELEASE OF INFORMATION CHILD 04-24A-P.dot
2017-02-17
* REQUEST FOR ACCESS AND OR COPY OF PROTECTED HEALTH INFOMRATION EXPLANATION.docx
* REQUEST FOR ACCESS COPY OF PHI.doc
2017-02-17
* RMQ 072109 FARSI.pdf
* RMQ 072109 FARSI FORMFILL.docx
* RMQ ADULT OUTCOME EXPLANATION.docx
* RMQ FORM 093009 ENGLISH 01.05.2009.pdf
* UM REQUEST AND AUTHORIZATION.docx
* VITAL SIGNS WEIGHT HEIGHT RECORD EXPLANATION.docx
* VITALS FORMFILL.doc
2017-03-02
* YOUTH TRANSITION SELF EVALUATION ARABIC.doc
* YOUTH TRANSITION SELF EVALUATION ENGLISH.doc
2018-05-25
* YOUTH TRANSITION SELF EVALUATION EXPLANATION.docx
2018-05-25
* YOUTH TRANSITION SELF EVALUATION SPANISH.doc
2018-05-25
* YOUTH TRANSITION SELF EVALUATION VIETNAMESE.doc
2018-05-25
* TIERS VOCATIONAL EMPLOYMENT.docx
2018-05-25
* TRANSITIONAL AGE YOUTH REFERRAL P&P.doc
2017-03-02
* TRANSITIONAL YOUTH REFERRAL PLAN EXPLANATION.docx
2018-05-25
* TRANSITIONAL YOUTH REFERRAL PLAN FORM FILL.doc
2018-05-25
* SAFETY ALERT PAPER FORM INSTRUCTIONS.doc
2017-03-02
* SAFETY ALERTS EXPLANATION.docx
2018-05-25
* SATS-R FORM 2.doc
2017-03-02
* STRENGTHS TABLE.docx
2018-05-25
* TBS CLIENT PLAN FORM FILL.docx
2018-05-25
* TBS CLIENT PLAN SIGNATURE PAGE.docx
2018-05-25
* TIERS ABUSE ADDICTION.docx
2018-05-25
* TIERS BASIC NEEDS.docx
2018-05-25
* TIERS EDUCATION.docx
2018-05-25
* TIERS FAMILY STRESS.docx
2018-05-25
* TIERS FINANCIAL.docx
2018-05-25
* TIERS IDENTITY ISSUES.docx
2018-05-25
* TIERS INTIMATE RELATIONSHIPS.docx
2018-05-25
* TIERS LACK OF PHYSICAL HEALTH CARE.docx
2018-05-25
* TIERS LEGAL.docx
2018-05-25
* TIERS MEANINGFUL ROLE.docx
2018-05-25
* TIERS NEGLECT ABUSE.docx
2018-05-25
* TIERS NEUROLOGICAL BRAIN IMPAIRMENT.docx
2018-05-25
* TIERS PHYSICAL HEALTH PROBLEMS.docx
2018-05-25
* TIERS POTENTIAL FOR HARM.docx
2018-05-25
* TIERS SOCIAL FUNCTIONING.docx
2018-05-25
* TIERS SPIRITUAL.docx
2018-05-25
* TIERS STRESS.docx
2018-05-25
* TIERS TABLE EXPLANATION.docx
2018-05-25
* TIERS TRAUMA.docx
2018-05-25
* BHA - DEC FORM FILL.docx
2017-03-28
* BHA - 0-5 FORMFILL.docx
2017-03-29
* INFORMED CONSENT PSYCHOTROPIC MEDICATION VIETNAMESE.docx
2017-04-04
* INFORMED CONSENT PSYCHOTROPIC MEDICATION TAGALOG.docx
2017-04-04
* INFORMED CONSENT PSYCHOTROPIC MEDICATION SPANISH.docx
2017-04-04
* INFORMED CONSENT PSYCHOTROPIC MEDICATION ARABIC.docx
2017-04-04
* INFORMED CONSENT PSYCHOTROPIC MEDICATION ENGLISH.docx
2017-04-04
* BHA - TBS FORMFILL.doc
2017-06-14
* CLIENT PLAN FORM FILL.docx
2017-06-30
* MEDS MANAGEMENT LONG NOTE FORM FILL.doc
2017-06-30
* INTENSIVE SERVICE REQUEST ISR EXPLANATION.pdf
2017-06-30
* INTENSIVE SERVICE REQUEST ISR FORM FILL.doc
2017-06-30
* CONSENT FOR SERVICES ARABIC.docx
2017-08-07
* CONSENT FOR SERVICES SPANISH.docx
2017-08-07
* CONSENT FOR SERVICES TAGALOG.docx
2017-08-07
* CONSENT FOR SERVICES VIETNAMESE.docx
2017-08-07
* DISCHARGE SUMMARY PAPER FORM INSTRUCTIONS.doc
2017-08-15
* AUTHORIZATION TO USE OR DISCLOSE PHI FARSI.pdf
2017-09-14
* AUTHORIZATION TO USE OR DISCLOSE PHI FORM FILL FARSI.docx
2017-09-14
* CONSENT FOR SERVICES FARSI.pdf
2017-09-14
* CONSENT FOR SERVICES FORM FILL FARSI.docx
2018-05-25
* INFORMED CONSENT PSYCHOTROPIC MEDICATION FARSI.pdf
2017-09-14
* INFORMED CONSENT PSYCHOTROPIC MEDICATION FORM FILL FARSI.docx
2017-09-14
* MY SAFETY PLAN FARSI.pdf
2017-09-14
* MY SAFETY PLAN FORM FILL FARSI.docx
2017-09-14
* YOUTH TRANSITION SELF EVALUATION FARSI.pdf
2017-09-14
* YOUTH TRANSITION SELF EVALUATION FORM FILL FARSI.docx
2017-09-14
* CASE MANAGEMENT PROGRESS NOTE FORM FILL.doc
2017-10-06
* FAMILY PSYCHOTHERAPY PROGRESS NOTE FORM FILL.doc
2017-10-06
* FAMILY REHAB PROGRESS NOTE FORM FILL.doc
2017-10-06
* GROUP PSYCHOTHERAPY PROGRESS NOTE FORM FILL.doc
2017-10-06
* GROUP REHAB PROGRESS NOTE FORM FILL.doc
2017-10-06
* WRAPAROUND PROGRESS NOTE FORM FILL.doc
2017-10-06
* INDIVIDUAL PSYCHOTHERAPY PROGRESS NOTE FORM FILL.doc
2017-10-11
* Explanation for Eligibility form 10-25-17.pdf
2017-10-25
* BHA - ADULT FORM FILL.doc
2017-11-28
* BHA - CHILDREN FORM FILL.docx
2017-11-28
* INITIAL SCREENING PERT PAPER FORM INSTRUCTIONS.doc
2017-11-28
* INITIAL SCREENING PERT FORMFILL.docx
2017-11-28
* INDIVIDUAL PROGRESS NOTE OTHER FORM FILL.doc
2017-12-15
* ESU NURSING NOTE FORM FILL.docx
2018-01-04
* INDIVIDUAL REHAB PROGRESS NOTE FORM FILL.doc
2018-01-09
* TIERS EMOTIONAL BEHAVIORAL PSYCHIATRIC.docx
2018-02-09
* AUTHORIZATION TO USE OR DISCLOSE PHI EXPLANATION.docx
2018-02-09
* DEMOGRAPHIC FORM FILL.docx
2018-02-13
* DIAGNOSIS FORM EXPLANATION.docx
2018-02-13
* DISCHARGE SUMMARY EXPLANATION.docx
2018-02-13
* DISCHARGE SUMMARY FORMFILL.docx
2018-02-13
* BHA - EXPLANATION.docx
2018-02-13
* BHA - ESU EXPLANATION.docx
2018-02-13
* BHA - START FORM FILL.doc
2018-02-13
* BHA - TBS EXPLANATION.docx
2018-02-13
* DIAGNOSIS FORM.docx
2018-02-13
* INITIAL SCREENING ESU FORMFILL.doc
2018-02-13
* INITIAL SCREENING FORMFILL.doc
2018-02-13
* SAFETY ALERTS FORMFILL.doc
2018-02-13
* CFARS EXPLANATION.docx
2018-02-13
* CFARS FORMFILL.doc
2018-02-13
* IMR ADULT OUTCOMES EXPLANATION.docx
2018-02-13
* LOCUS ADULT OUTCOMES EXPLANATION.docx
2018-02-13
* MORS ADULT OUTCOME EXPLANATION.docx
2018-02-13
* SATS-R ADULT OUTCOME EXPLANATION.docx
2018-02-13
* UM REQUEST AND AUTHORIZATION EXPLANATION.docx
2018-02-13
* TBS TREATMENT PLAN EXPLANATION.docx
2018-02-13
* WEEKLY SUMMARY EXPLANATION.docx
2018-02-13
* PRROGRESS NOTES EXPLANATION.docx
2018-02-13
* AIMS FORMFILL.doc
2018-02-13
* PSYCHIATRIC ASSESSMENT FORMFILL.doc
2018-02-13
* CLIENT PLAN - ADULT EXPLANATION.docx
2018-02-13
* CLIENT PLAN - CHILDREN EXPLANATION.docx
2018-02-13
* MEDICATION PROGRESS NOTE SC24.docx
2018-05-01
* MEDICATION PROGRESS NOTE SC25.docx
2018-05-01
* MEDICATION PROGRESS NOTE SC26.docx
2018-05-01
* MEDICATION PROGRESS NOTE SC27.docx
2018-05-01
* AOA Patient Medication Agreement English (pdf)
2018-06-08

UTTM

Name Description Date
* QI...Up to the Minute - February 2018
2018 2018-03-19
* QI...Up to the Minute - April 2014
2014 2016-05-24
* QI...Up to the Minute - April 2015
2015 2016-05-25
* QI...Up to the Minute - April 2016
2016 2016-05-25
* QI...Up to the Minute - April 2017
2017 2017-04-18
* QI...Up to the Minute - April 2018
2018 2018-04-16
* QI...Up to the Minute - August 2014
2014 2016-05-24
* QI...Up to the Minute - August 2015
2015 2016-05-24
* QI...Up to the Minute - August 2016
2016 2016-08-17
* QI...Up to the Minute - August 2017
2017 2017-11-28
* QI...Up to the Minute - December 2013
2013 2016-05-24
* QI...Up to the Minute - December 2014
2014 2016-05-24
* QI...Up to the Minute - December 2016
2016 2017-01-03
* QI...Up to the Minute - December 2017
2017 2018-02-15
* QI...Up to the Minute - FY 2014-2015
2014-2015 2018-02-09
* QI...Up to the Minute - FY 2015-2016
2015-2016 2018-02-09
* QI...Up to the Minute - FY 2016-2017
2016-2017 2018-02-09
* QI...Up to the Minute - FY 2017-2018
2017-2018 2018-02-09
* QI...Up to the Minute - February 2016
2016 2016-05-25
* QI...Up to the Minute - February 2017
2017 2017-02-16
* QI...Up to the Minute - Febuary 2015
2015 2016-05-24
* QI...Up to the Minute - January 2016
2016 2016-05-25
* QI...Up to the Minute - January 2017
2017 2017-01-24
* QI...Up to the Minute - January 2018
2018 2018-01-30
* QI...Up to the Minute - July 2014
2014 2016-05-25
* QI...Up to the Minute - July 2015
2015 2016-05-24
* QI...Up to the Minute - July 2016
2016 2016-07-19
* QI...Up to the Minute - July 2017
2017 2017-11-28
* QI...Up to the Minute - June 2014
2014 2016-05-24
* QI...Up to the Minute - June 2016
2016 2016-06-16
* QI...Up to the Minute - June 2017
2017 2017-11-28
* QI...Up to the Minute - March 2015
2015 2016-05-25
* QI...Up to the Minute - March 2016
2016 2016-05-24
* QI...Up to the Minute - March 2017
2017 2017-11-29
* QI...Up to the Minute - March 2018
2018 2018-03-19
* QI...Up to the Minute - May 2014
2014 2016-05-24
* QI...Up to the Minute - May 2016
2016 2016-05-26
* QI...Up to the Minute - May 2017
2017 2017-05-22
* QI...Up to the Minute - May 2018
2018 2018-05-18
* QI...Up to the Minute - May/June 2015
2015 2016-05-24
* QI...Up to the Minute - November 2014
2014 2016-05-24
* QI...Up to the Minute - November 2017
2017 2018-02-15
* QI...Up to the Minute - November/December 2015
2015 2016-05-24
* QI...Up to the Minute - October 2014
2014 2016-05-24
* QI...Up to the Minute - October 2015
2015 2016-05-24
* QI...Up to the Minute - October 2016
2016 2016-10-24
* QI...Up to the Minute - October 2017
2017 2018-02-15
* QI...Up to the Minute - September 2014
2014 2016-05-25
* QI...Up to the Minute - September 2015
2015 2016-05-25
* QI...Up to the Minute - September 2017
2017 2018-02-15

Training

Progress Notes v3 Video Tutorials available online.

Access to Services Journal Video Tutorial available online.

PWB

BHS Reports