SUD Secure Documents

SUDPOH

Appendix F.4 – Payment Recovery Form (Void-Disallowance) (xlsx)
Updated 06-15-2019 2019-07-22
Appendix F.5 – Claims Adjustment Form (Valid Denial) (xlsx)
Revised 07-01-19 2019-07-22
Appendix F.8 – DPC 203 Mobile Devices (2019) (xls)
2019-07-22
Contractors' Inventory List
2019-07-22
County of San Diego
2018-08-22
County of San Diego
2018-12-20
County of San Diego
2018-12-20
DPC 203 - BHS Contracts
2019-07-22
SERIOUS INCIDENT ROOT CAUSE ANALYSIS WORKSHEET
2018-07-11
SUDPOH Appendix D.4 - Group Counseling Sign In Sheet Form Fill 06-06-19 (pdf)
Updated 06-06-19 2019-06-11
SUDPOH Appendix E.4 - Program Accessibility Assessment 4-2018 (docx)
2018-07-11
SUDPOH Appendix F.2 - Gift Card Approval Form (xlsx)
2017-10-16
SUDPOH Appendix F.9 - DPC203 Mobile Devices SUPPLEMENTAL 2017 (xls)
2018-08-22
SUDPOH Summary of Changes 3-1-19 (pdf)
2019-03-08
Substance Use Disorder Provider Operations Handbook - SUDPOH 07/11/2019 (pdf)
Revised 07-11-19 2019-07-22

SUDURM

03 - Section 1 Detail 01-14-19 (pdf)
2019-02-11
101a Instruction Client Tracking 01-03-19 (pdf)
2019-02-11
101b Client Tracking 01-03-19 (pdf)
2019-02-11
102a-1 Instruction QAR Initial Review Form 08-13-18 (pdf)
2018-08-14
102b-1 Instruction QAR Extension-Stay-Discharge Form 08-13-18 (pdf)
2018-08-14
102b-2 SUD Extension QAR Review Form 08-10-18 (pdf)
2018-08-13
103 Instruction Medi-Cal Eligibility Printout (pdf)
2019-02-11
104a Instruction Supplement Minor Children 04-12-17 (pdf)
2018-01-24
104a Minor Children Form 04-12-17 (pdf)
2018-01-24
104b-1 Instructions Brief ASAM Screening 01-07-19 (pdf)
2019-02-11
104b-2 Brief ASAM Screening Tool Hard Copy 01-07-19 (pdf)
2019-02-11
104b-3 Brief ASAM Screening Tool Form Fill 01-07-19 (pdf)
2019-02-11
105 Placement Fee Collection 4-12-17 (pdf)
2017-05-01
106 Placement-ID-SS-Medi Cal Cards (pdf)
2018-07-06
107a Financial Responsibility Info and MC SOC 1-30-19 (pdf)
2019-02-11
107b Financial Responsibility Information and MC SOC 1-30-19 (pdf)
2019-02-11
108 Placement - SanWITS Admission Profile 01-14-19 (pdf)
2019-02-11
202 Placement-Admissions Agreement-Consent to Treatment 4-12-17 (pdf)
2017-05-01
203a Instructions Personal Rights At An AOD Certified Program 7-26-18 (pdf)
2018-08-10
203b Personal Rights At An AOD Certified Program 7-26-18 (pdf)
2018-08-10
204 Placement-42 CFR Written Summary Requirements 7-2-18 (pdf)
2018-07-06
205 Placement-Notice of Privacy-HIPAA 4-12-17 (pdf)
2017-05-01
206 Placement-Consent to Follow up 4-12-17 (pdf)
2017-05-01
207 Placement-Consent for photo-tv-video 4-12-17 (pdf)
2017-05-01
210a Instructions SUD Program Admission Checklist 6-27-18 (pdf)
2018-07-06
210b SUD Program Admission Checklist 1-3-19 (pdf)
2019-02-11
300 Section 3 Detail 7-3-18 (pdf)
2018-07-06
302a Instruction Alcohol and Drug Hx 4-12-17 (pdf)
2017-05-01
302b Alcohol and Drug History Form 4-12-17 (pdf)
2017-05-01
303a Instruction ASI-YAI 01-11-19 (pdf)
2019-02-11
304a Instruction Co-occurring Form 4-12-17 (pdf)
2017-05-01
306a Instructions ASAM Level of Care Recommendation 01-04-19 (pdf)
2019-02-11
306b ASAM LOC Recommendation 6-11-18 (pdf)
2018-07-06
307a Instructions Assessment Summary 01-11-19 (pdf)
2019-02-11
307b Assessment Summary 06-26-18 (pdf)
2018-07-06
307c Assessment Summary Form Fill 06-26-18 (pdf)
2018-07-06
308a Instructions Diagnosis Determination Note 01-11-19 (pdf)
2019-02-11
400 Section 4 Detail 01-14-19 (pdf)
2019-02-11
401a Instruction WM Observation Log 9-25-18 (pdf)
2018-10-11
402a Instruction Centrally Stored Medication & Destruction Record 4-12-17 (pdf)
2018-07-06
403a Instruction Health Questionnaire Form 9-30-18 (pdf)
2018-10-11
403b Health Questionnaire 09-25-18 (pdf)
2018-10-11
404b TB screening form 4-12-17 (pdf)
2017-05-01
406 Physician Direction Form 4-12-17 (pdf)
2017-05-01
407 MD Recomendation to client 4-12-17 (pdf)
2017-05-01
408 Placement - Proof of Pregnancy 01-11-19 (pdf)
2019-02-11
500 Section 5 Detail 01-14-19 (pdf)
2019-02-11
503a Instructions Treatment Plan Addendum 01-11-19 (pdf)
2019-02-11
503b Treatment Plan Addendum 6-11-18 (pdf)
2018-07-09
505a Instructions Treatment Effectiveness Assessment 01-09-19 (pdf)
2019-02-11
505b Treatment Effectiveness Assessment 01-09-19 (pdf)
2019-02-11
600 Section 6 Detail 01-15-19 (pdf)
2019-02-11
602a-1 Instructions for Residential Weekly Progress Note - Narrative 01-24-19 (pdf)
2019-02-11
602a-2 Weekly Progress Note Residential - Narrative - Hard Copy 6-27-18 (pdf)
2018-07-06
602a-3 Weekly Progress Note Residential - Narrative - Form Fill 6-27-18 (pdf)
2018-07-06
602b-1 Instructions for Residential Weekly Progress Note - Services 01-24-19 (pdf)
2019-02-11
602b-2 Weekly Progress Note Residential - Services 06-19-18 (pdf)
2018-07-06
603a Instructions Residential WM Daily Progress Note 10-5-18 (pdf)
2018-10-11
603b Residential WM Daily Progress Note – Hard Copy 10-05-18 (pdf)
2018-10-11
603c Residential WM Daily Progress Note Form Fill 10-03-18 (pdf)
2018-10-11
700 Section 7 Detail 01-15-19 (pdf)
2019-02-11
703 Placement - SanWITS Discharge Profile 01-14-19 (pdf)
2019-02-11
704a Instruction Client Discharge Plan 4-12-17 (pdf)
2017-05-01
800 Section 8 Detail 01-15-19 (pdf)
2019-02-11
801a Instruction Drug Test and Results Log 01-11-19 (pdf)
2019-02-11
801b Drug Test and Result Log Form (pdf)
2017-05-01
802 placement Drug Test Results From Lab 4-12-17 (pdf)
2017-05-01
803 placement Progress Reports (pdf)
2017-05-01
805 placement Referral Source Documents (pdf)
2017-05-01
806a FAX COVER SHEET FOR RSUD AUTH (docx)
2018-08-02
806b FAX COVER SHEET FOR RSUD AUTH Form Fill (pdf)
2018-08-02
807 Placement - SanWITS Residential Authorization Printout (pdf)
2019-02-11
ASI Lite CF
2017-04-27
County of San Diego, Department of Health Services, Alcohol and Drug Services
2018-08-13
DHCS 5078 - Centrally Stored Medication and Destruction Record (07/13)
2017-04-27
DUAL DIAGNOSIS CO-OCCURRING CONDITION
2017-04-27
DUAL DIAGNOSIS CO-OCCURRING CONDITION
2017-04-27
McALISTER INSTITUTE
2018-10-11
Youth Assessment Index ver. 2.0c
2018-09-11