BHS Provider Documents

Arabic


MY_SAFETY_PLAN_FORM_FILL_ARABIC.docx		2018-01-19
INFORMED_CONSENT_PSYCHOTROPIC_MEDICATION_ARABIC.docx		2017-04-04
Authorization to Use of Disclose PHI - ARABIC (pdf)	Arabic	2017-02-17
CANS Family Letter - Arabic (pdf)		2019-04-10
CONSENT FOR SERVICES ARABIC (docx)	Revised 01/31/2023	2023-03-14
FINAL Coordination of Care Form-Arabic (pdf)		2016-07-13
PSC-Parent (Arabic)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (Arabic)_6_2018_interactive (pdf)		2020-03-25
YOUTH TRANSITION SELF EVALUATION ARABIC (doc)		2023-05-09

Chinese


CONSENT FOR SERVICES - Chinese (doc)		2023-03-14

Dari


CONSENT FOR SERVICES - Dari (doc)	Revised 01/31/2023	2023-03-14

Farsi


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
AUTHORIZATION TO USE OR DISCLOSE PHI FARSI (pdf)	Uploaded 07-23-2019	2019-07-23
CANS Family Letter - Farsi (pdf)		2019-04-10
CONSENT FOR SERVICES - FARSI (docx)	Revised 01/31/2023	2023-03-14
PSC-Parent (Farsi)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (Farsi)_6_2018_interactive (pdf)		2020-03-25
YOUTH TRANSITION SELF EVALUATION FARSI (doc)		2023-05-09

Korean


CONSENT FOR SERVICES - Korean (doc)	Revised 01/31/2023	2023-03-14

Somali


CONSENT FOR SERVICES - Somali (doc)	Revised 01/31/2023	2023-03-14

Spanish


AOA_PATIENT_MEDICATION_AGREEMENT_-_SPANISH.DOCX		2018-07-11
Authorization to Use or Disclose PHI - SPANISH (pdf)	Spanish	2017-02-17
CANS Family Letter - Spanish (pdf)		2019-04-10
CONSENT FOR SERVICES SPANISH (docx)	Revised 01/31/2023	2023-03-14
FINAL Coordination of Care Form-Spanish (pdf)		2016-07-13
INFORMED CONSENT PSYCHOTROPIC MEDICATIONS SPANISH (docx)		2021-03-05
MY SAFETY PLAN FORM FILL SPANISH (docx)	Revised 09/12/2019	2019-09-13
PSC- Parent Spanish 6 2018 Interactive (pdf)		2020-03-26
PSC- Youth Spanish 6 2018 Interactive (pdf)		2020-03-26
YOUTH TRANSITION SELF EVALUATION SPANISH (doc)		2018-05-25

Tagalog


INFORMED_CONSENT_PSYCHOTROPIC_MEDICATION_TAGALOG.docx		2017-04-04
MY_SAFETY_PLAN_FORM_FILL_TAGALOG.docx		2018-01-19
Authorization to Use or Disclose PHI - TAGALOG (pdf)	Tagalog	2017-02-17
CANS Family Letter - Tagalog (pdf)		2019-04-10
CONSENT FOR SERVICES - TAGALOG (docx)	Revised 01/31/2023	2023-03-14
FINAL Coordination of Care Form-Tagalog (pdf)		2016-07-13
PSC-Parent (TG)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (TG)_6_2018_interactive (pdf)		2020-03-25

Vietnamese


MY_SAFETY_PLAN_FORM_FILL_VIETNAMESE.docx		2018-01-19
YOUTH_TRANSITION_SELF_EVALUATION_VIETNAMESE.doc		2018-05-25
INFORMED_CONSENT_PSYCHOTROPIC_MEDICATION_VIETNAMESE.docx		2017-04-04
Authorization to Use or Disclose PHI - VIETNAMESE (pdf)	Vietnamese	2017-02-17
CANS Family Letter - Vietnamese (pdf)		2019-04-10
CONSENT FOR SERVICES - Vietnamese (docx)	Revised 1/31/2023	2023-03-14
FINAL Coordination of Care Form-Viet (pdf)		2016-07-13
PSC-Parent (VI)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (VI)_6_2018_interactive (pdf)		2020-03-25

UTTM


QM...Up to the Minute - May 2023 (pdf)	2022 - 2023	2023-05-12
QM...Up to the Minute - April 2023 (pdf)	2023	2023-04-14
QM...Up to the Minute - March 2023 (pdf)	2023	2023-03-14
QM...Up to the Minute - February 2023 (pdf)	2023	2023-02-10
QM...Up to the Minute - January 2023 (pdf)	2023	2023-01-13
QM...Up to the Minute -December 2022 (pdf)	2022	2022-12-13
QM...Up to the Minute -November 2022 (pdf)	2022	2022-11-14
QM...Up to the Minute - October 2022 (pdf)	2022	2022-10-18
QM...Up to the Minute - September 2022 (pdf)	2022	2022-10-18
QI...Up to the Minute - FY 2021 -2022 (pdf)	2021 - 2022	2022-09-20
QM...Up to the Minute - August 2022 (pdf	2022	2022-08-12
QM...Up to the Minute - July 2022 (pdf)	2022	2022-07-20
QM...Up to the Minute - June 2022 (pdf)	2022	2022-06-10
QM...Up to the Minute - May 2022 (pdf)	2022	2022-05-13
QM...Up to the Minute - February 2022 (pdf)	2022	2022-02-10
QM...Up to the Minute - April 2022 (pdf)	2022	2022-04-15
QM...Up to the Minute - January 2022 (pdf)	2022	2022-01-25
QM...Up to the Minute - March 2022 (pdf)	2022	2022-03-30
QM...Up to the Minute - November 2021 (pdf)	2021	2021-11-12
QM...Up to the Minute - October 2021 (pdf)	2021	2021-10-14
QM...Up to the Minute - May 2021 (pdf)	2021	2021-05-17
QM...Up to the Minute - December 2021 (pdf)	2021	2021-12-13
QM...Up to the Minute -September 2021 (pdf)	2021	2021-09-10
QM...Up to the Minute - June 2021 (pdf)	2021	2021-06-10
QM...Up to the Minute - August 2021 (pdf)	2021	2021-08-12
QM...Up to the Minute - July 2021 (pdf)	2021	2021-07-08
QM...Up to the Minute - April 2021 (pdf)	2021	2021-04-09
QM...Up to the Minute - March 2021 (pdf)	2021	2021-03-12
QM...Up to the Minute -February 2021 (pdf)	2021	2021-02-12
QM...Up to the Minute - January 2021 (pdf)	2021	2021-01-15


QI...Up to the Minute - FY 2019 -2020 (pdf)	2020	2020-07-31
QM...Up to the Minute - February 2020 (pdf)	2020	2020-02-13
QM...Up to the Minute - January 2020 (pdf)	2020	2020-02-13
QM...Up to the Minute - September 2020 (pdf)	2020	2020-09-11
OM...Up to the Minute - May 2020 (pdf)	2020	2020-05-15
QM...Up to the Minute - April 2020 (pdf)	2020	2020-04-09
QM...Up to the Minute - August 2020 (pdf)	2020	2020-08-13
QM...Up to the Minute - December 2020 (pdf)	2020	2020-12-16
QM...Up to the Minute - July 2020	2020	2020-07-10
QM...Up to the Minute - June 2020	2020	2020-06-12
QM...Up to the Minute - March 2020 (pdf)	2020	2020-03-31
QM...Up to the Minute - November 2020 (pdf)	2020	2020-11-12
QM...Up to the Minute - October 2020 (pdf)	2020	2020-10-09


QM...Up to the Minute - October 2019 (pdf)	2019	2019-10-10
QI...Up to the Minute - June 2019 (pdf)	2019	2019-07-11
QI...Up to the Minute - April 2019 (pdf)	2019	2019-04-12
QI...Up to the Minute - August 2019 (pdf)	2019	2019-08-14
QI...Up to the Minute - FY 2018-2019 (pdf)	2018-2019	2019-09-24
QI...Up to the Minute - February 2019 (pdf)	2019	2019-02-15
QI...Up to the Minute - January 2019 (pdf)	2019	2019-01-10
QI...Up to the Minute - March 2019 (pdf)	2019	2019-03-14
QI...Up to the Minute - May 2019 (pdf)	2019	2019-05-10
QM...Up to the Minute - December 2019 (pdf)	2019	2020-02-13
QM...Up to the Minute - July 2019 (pdf)	2019	2019-07-23
QM...Up to the Minute - November 2019 (pdf)	2019	2019-11-20
QM...Up to the Minute - September 2019 (pdf)	2019	2019-09-24


QI...Up to the Minute - August 2018 (pdf)	FY18-19	2021-06-10
QI...Up to the Minute - December 2018 (pdf)	FY18-19	2021-06-10
QI...Up to the Minute - July 2018 (pdf)	FY18-19	2021-06-10
QI...Up to the Minute - November 2018 (pdf)	FY18-19	2021-06-10
QI...Up to the Minute - October 2018 (pdf)	FY18-19	2021-06-10
QI...Up to the Minute - September 2018 (pdf)	FY18-19	2021-06-10

Training

CCBH Training page - Tips and Resources

Training Classes Video Tutorials and Resource Packets

Admin Data Entry

Service Entry Training

Scheduler Orientation and Practice Exercises

Assessments Orientation and Practice Exercises

Crisis House Assessments Orientation and Practice Exercises

Client Plans and Progress Notes Orientation and Practice Exercises

Progress Notes Orientation and Practice Exercises

Doctor's Homepage Orientation and Practice Exercises

View Only Assessments

TBS Client Plans and Progress Notes Orientation and Practice Exercises

CCBH Login Process Tutorial

Admin Data Entry Resource Packet (pdf)

Service Entry Resource Packet (pdf)

Scheduler Resource Packet (pdf)

Assessments Resource Packet (pdf)

Crisis House Assessments Resource Packet (pdf)

Progress Notes Resource Packet (pdf)

DHP Resource Packet (pdf)

View Only Resource Packet (pdf)

Progress Note Correction Resources

Progress Notes Correction Video Tutorials

Billing Correction Tutorials

Other Training Resources and Tip SheetS

Reports Demonstration

CCBH Reports Manual (pdf )

Access to Services Journal Video Tutorial

Covid-19 Dashboard Tutorial available online (new)
Claim It Anyway (CIA) Webinar available online (new)
Access to Services Journal Video Tutorial available online.
NOABD Webinar available online
Service Indicators Webinar available online

New Program Manager Orientation Presentation (pptx)

PWB


Explanation_for_Eligibility_form-10-25-17.pdf		2017-11-07
Eligibility-for-PWB-and-Enhanced-Services-Form-Fill-09.20.2017.docx		2017-11-07
Child and Family Team (CFT) Meeting Note Explanation (pdf)	Revised 01/14/2021	2021-02-11
Child and Family Team CFT Meeting Note Form Fill 11.30.2021 (docx)		2021-12-02
Intensive Care Coordination (ICC) (pdf)		2018-06-21
Intensive Care Coordination (ICC) Note Explanation (pdf)		2018-10-30
Progress Report to Child Welfare Services Explanation (pdf)	Updated 04/01/2023	2023-04-21
Progress Report to Child Welfare Services Form Fill (pdf)	Revised 04/01/2023	2023-04-21

BHS Reports


AOA Annual Medication Monitoring Report FY 16-17 (pdf)		2017-11-30
AOA Annual Medication Monitoring Report Q2 FY17-18 (pdf)		2018-02-12
BHS Dashboard October 2017 (pdf)		2017-11-07
BHSDatabook_FY16-17_Final.pdf		2018-02-09
BHSDatabook_FY2014-15.pdf		2016-05-25
CYF Annual Medication Monitoring Report FY 16-17 (pdf)		2017-11-30
CYF Medication Monitoring Report Q2 FY17-18 (pdf)		2018-02-12
FY_2016-17_BHS_Factsheet_Combined_FINAL.pdf		2018-02-09
Medical Record Reviews FY 2017-18 Trending Questions Summary AOA and CYF Programs Q3 FY 2017-18 (pdf)		2018-05-01
Mental Health Performance Dashboard Combined - FY2017-18 (pdf)		2018-01-22
QM - MRR - Trending Questions Report - Q1 FY 18-19 (pdf)		2018-10-05
QM - MRR - Trending Questions Report - Q1 FY 19-20 (pdf)		2019-10-25
QM - MRR - Trending Questions Report - Q2 FY 18-19 (pdf)		2019-01-24
QM - MRR - Trending Questions Report - Q3 FY 18-19 (pdf)		2019-05-01
QM – MRR – Trending Questions – Q1 FY 20-21 (pdf)		2020-10-28

STRTP


AB1299 STRTP Admission Report (docx)	Revised 03/24/2022	2022-06-03
AB1299 STRTP Admission Report Explanation Form (pdf)	Revised 03/24/2022	2022-06-03
BHS Contractor Memo – Tracking Out of County Medi-Cal Beneficiaries in CCBH – Revised AB1299 STRTP Admission Report (pdf)	Memo Date 03/04/2022	2022-06-03
BHS Contractor Memo-Revised AB1299 STRTP Admission Report (pdf)	Memo Date : 03/02/20121	2021-03-02
BHS Contractor Memo-Revised STRTP Forms - Effective November 2020 (pdf)	Memo - 11/20/2020	2020-11-25
CYF MEMO – STRTP Release of Forms 08/16/19 (pdf)		2019-08-20
Daily Progress Note (docx)		2023-01-05
Daily Progress Note Explanation Sheet (docx)		2023-01-05
Optional AB1299 STRTP Tracking Tool (xlsx)	Revised 03/02/2021	2021-03-02
STRTP ADMISSION STATEMENT FORM FILL (docx)		2020-11-25
STRTP ADMISSION STATEMENT – EXPLANATION (pdf)	Revised 06/24/2019	2020-11-25
STRTP DISCHARGE SUMMARY FORM FILL (docm)		2020-11-25
STRTP DISCHARGE SUMMARY – EXPLANATION (pdf)	Revised 07/12/2019	2020-11-25
STRTP Hybrid Matrix (docx)	Revised 12/10/2020	2020-12-11
STRTP MEDICATION NOT PRESCRIBED PROGRESS NOTE SC11 (docx)		2020-11-25
STRTP Medication Flow Chart (pdf)	Uploaded 07-05-2019	2019-07-05
STRTP PRIOR AUTHORIZATION DAY SERVICES REQUEST (docx)	Revised 04/01/2022	2022-03-25
STRTP PRIOR AUTHORIZATION DAY SERVICES REQUEST - EXPLANATION (docx)		2022-06-10
STRTP TRANSITION DETERMINATION PLAN FORMFILL (docx)	Revised 09/02/2021	2021-09-07
STRTP Transition Determination Plan Explanation Form (docx)	Revised 09/02/2021	2021-09-07
STRTP UM Request Form (docx)	Revised 11/01/2022	2022-11-17
STRTP Utilization Management Request Explanation Form (pdf)	Revised 11/01/2022	2022-11-17
Transition Determination Plan Signature Page (docx)	Revised 09/02/2021	2021-09-07

TFC


ANNUAL TFC PARENT EVALUATION FORM FILL (docx)		2020-11-25
ANNUAL TFC PARENT EVALUATION – EXPLANATION (pdf)		2020-11-25
ANNUAL TFC PARENT SELF -EVALUATION FORM FILL (docx)		2020-11-25
ANNUAL TFC PARENT SELF-EVALUATION FORM – EXPLANATION (pdf)		2020-11-25
BHS Contractor Memo-TFC Forms Effective December 2020 (pdf)	Memo - 11/23/2020	2020-11-25
TFC ANNUAL PARENT AGREEMENT AND CERTIFICATION FORM FILL (docx)		2020-11-25
TFC CLINICAL DOCUMENTATION TIP SHEET (pdf)		2020-11-25
TFC DAILY PROGRESS NOTE - EXPLANATION (pdf)	Revised 03/01/2023	2023-03-03
TFC DAILY PROGRESS NOTE FORMFILL (doc)	Revised 03/01/2023	2023-03-03
TFC PARENT DOCUMENTATION TIP SHEET (pdf)		2020-11-25
TFC PRIOR AUTHORIZATION REQUEST (docx)	Revised 04/01/2022	2022-03-25
TFC PRIOR AUTHORIZATION REQUEST - EXPLANATION (docx)	Revised 04/01/2022	2022-03-25

Peer Support Specialist


BHS HPA Peer Support Specialist Services Q and A (pdf)	Updated 06/01/2023	2023-06-01
San Diego Certified Peer Support Specialists – BILLING CODES (pdf)	Revised 05/30/2023	2023-05-30
San Diego Certified Peer Support Specialist – TRAINING REQUIRMENTS (docx)		2023-05-25
2023-05-17-BHS Memo-Update on Peer Support Services Implementation (pdf)		2023-05-25
Scholarship Flyer Peer Support Specialist Certification Program (pdf)		2022-10-18
Certified Peers (pdf)	Updated 03/2022	2022-05-16
Scholarship Flyer_Peer Support Specialist Certification Program (pdf)		2022-05-13
BHS Contractor Memo - BHS Peer Support Specialist Certification Program (pdf)	10/05/2021	2021-10-08

Billing Unit/Finance

Billing Unit Manuals

Financial Eligibility and Billing Manual (pdf)

Billing Unit Resources

Billing Unit Forms

CalAIM


BHS Contractor Memo-CalAIM Documentation Reform (pdf)	05/22/2022	2022-05-24
DHCS CalAIM Behavioral Health FAQ (pdf)		2023-01-03

TBS


BHA - TBS EXPLANATION (docx)	Revised 02/02/2022	2022-02-04
BHA TBS Form Fill (doc)	Revised 02/02/2022	2022-02-07
Brochure - English & Spanish 2.2023		2023-02-16
TBS CLIENT PLAN FORM FILL (docx)		2018-05-25
TBS CLIENT PLAN SIGNATURE PAGE (docx)		2018-05-25
TBS One Pager for Providers (pdf)		2023-02-15
TBS Overview PPT (pdf)		2023-02-15
TBS PRIOR AUTHORIZATION REQUEST AND REFERRAL FORM FILL (docx)	Revised 04/01/2022	2022-03-25
TBS PRIOR AUTHORIZATION REQUEST AND REFERRAL – EXPLANATION SHEET (docx)	Revised 04/01/2022	2022-03-25
TBS PROGRESS NOTE FORM_FILL (docx)		2020-08-07
TBS TREATMENT PLAN EXPLANATION (docx)		2018-02-13

Cerner Millennium


Cerner Millennium Introduction Meeting Presentation (pdf)	Presented 05/16/2023	2023-05-17


NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Modification_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Financial_Liability_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Language_Assistance_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Payment_Denial_Notice_-_ENGLISH.docx	-	2018-08-07
NOABD_Timely_Access_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Timely_Access_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Denial_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Your_Rights_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Timely_Access_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Modification_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Denial_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Termination_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Modification_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Payment_Denial_Notice_-_ARABIC.docx	-	2018-08-07
NOABD_Modification_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Financial_Liability_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Denial_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_VIETNAMESE.pdf	-	2018-08-07
NOABD_Your_Rights_Notice_-_FARSI.pdf	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Language_Assistance_Notice_-_ENGLISH.pdf	-	2018-08-07
NOABD_Your_Rights_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_SPANISH.pdf	-	2018-08-07
NOABD_Financial_Liability_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Timely_Access_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Termination_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Termination_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Termination_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Payment_Denial_Notice_-_VIETNAMESE.docx	-	2018-08-07
NOABD_Modification_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Modification_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Payment_Denial_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Financial_Liability_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Timely_Access_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_ENGLISH.pdf	-	2018-08-07
NOABD_Timely_Access_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_TAGALOG.pdf	-	2018-08-07
NOABD_Your_Rights_Notice_-_ARABIC.pdf	-	2018-08-07
NOABD_Denial_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Delivery_System_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Payment_Denial_Notice_-_FARSI.docx	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Financial_Liability_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Your_Rights_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Denial_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Financial_Liability_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Termination_Notice_-_FARSI.doc	-	2018-08-07
NOABD Log – FY 21-22 (xlsx)		2021-07-19
NOABD Denial Notice ENGLISH (doc)		2020-06-16
NOABD Payment Denial Notice SPANISH (docx)		2020-06-16
NOABD Table (pdf)	Revised 01/08/2020	2020-01-08
NOABD Termination Notice - SPANISH (doc)		2020-05-08
SanWITS NOABD		2019-10-25
SanWITS NOABD		2019-10-25


MHP Beneficiary Handbook_2.2023_Tagalog.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Spanish.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Korean.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Persian(Farsi).pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Arabic.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Vietnamese.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Dari.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Somali.pdf	Effective 03/12/2023	2023-03-10
MHP Beneficiary Handbook_2.2023_Chinese.pdf	Effective 03/12/2023	2023-03-10


Physician Notice to Patients California Regulation - Arabic (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Chinese (pdf)		2023-05-09
Physician Notice to Patients California Regulation - English (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Farsi (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Korean (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Spanish (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Tagalog (pdf)		2023-05-09
Physician Notice to Patients California Regulation - Vietnamese (pdf)		2023-05-09
Advance Directive - Farsi (pdf)		2023-05-04
Advance Directive – Arabic (pdf)		2023-05-04
Advance Directive - Dari (pdf)		2023-05-04
Advance Directive – Tagalog (pdf)		2023-05-04
Advance Directive – Spanish (pdf)		2023-05-04
Advance Directive – Vietnamese (pdf)		2023-05-04
Advance Directive – English (pdf)		2023-05-04
Advance Directive - Korean (pdf)		2023-05-04
Advance Directive – Chinese (Traditional) (pdf)		2023-05-04
Advance Directive – Somali (pdf)		2023-05-04
Limited English Proficiency Poster – Chinese (Traditional)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Spanish (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Korean (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Tagalog (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Dari (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Somali (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Vietnamese (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Arabic (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Farsi (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – English (pdf)	Revised 04/2023	2023-05-02
Open Payments Database Notice to Clients Display (docx)	Link	2023-05-01
Open Payments Database Physician Notice to Clients (docx)	Revised 01/19/2023	2023-05-01
CA Board of Psychology Consumer Statement - Korean (pdf)		2023-05-01
CA Board of Psychology Consumer Statement - Chinese (pdf)		2023-05-01
BBS Required Notice to Consumers 2022 (pdf)		2022-05-25
ACL Poster - Vietnamese (pdf)		2023-02-24
ACL Poster - Tagalog (pdf)		2023-02-24
ACL Poster - Arabic (pdf)		2023-02-24
ACL Poster - English (pdf)		2023-02-24
ACL Poster - Farci (pdf)		2023-02-24
ACL Poster - Spanish (pdf)		2023-02-24
01 - MHP Beneficiary Handbook Summary of Changes (pdf)	Revised February 2023	2023-02-09
San Diego Provider List Translation Instructions (pdf)		2021-07-19
SD Grievance - Appeal Brochure - Vietnamese (pdf)	Revised 08/27/2021	2022-03-30
SD Grievance - Appeal Brochure - Arabic (pdf)	Revised 08/27/2021	2022-03-30
SD Grievance - Appeal Brochure - English (pdf)	Revised 08/27/2021	2022-03-30
SD Grievance - Appeal Brochure - Farsi (pdf)	Revised 08/27/2021	2022-03-30
SD Grievance - Appeal Brochure - Spanish (pdf)	Revised 08/27/2021	2022-03-30
SD Grievance - Appeal Brochure - Tagalog (pdf)	Revised 08/27/2021	2022-03-30
Quick Guide To MH Services-Vietnamese (pdf)	Revised 08/27/2021	2022-03-17
Quick Guide To MH Services-Farsi (pdf)	Revised 08/27/2021	2022-03-17
Quick Guide To MH Services-Spanish (pdf)	Revised 08/27/2021	2022-03-17
Quick Guide To MH Services-English (pdf)	Revised 08/27/2021	2022-03-17
Quick Guide To MH Services-Arabic (pdf)	Revised 08/27/2021	2022-03-17
Quick Guide To MH Services-Tagalog (pdf)	Revised 08/27/2021	2022-03-17
Beneficiary Materials MHP Order Form (docx)	Revised 02/10/2022	2022-03-17
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 English (docx)	Revised 06/28/2018	2021-11-04
Grievance and Appeal Form – CCHEA OP Advocacy 7-1-18 Farsi (docx)		2021-09-14
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Arabic (docx)		2021-09-14
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Tagalog (docx)		2021-08-24
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Spanish (docx)		2021-08-24
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Vietnamese (docx)		2021-08-24
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Farsi (docx)		2021-08-24
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Arabic (docx)		2021-08-24
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Vietnamese (docx)		2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Tagalog (docx)		2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Spanish (docx)		2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - English (docx)		2021-08-23
NPP Acknowledgement Arabic (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement English (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Farsi (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Spanish (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Tagalog (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Vietnamese (pdf)	Revised August 2021	2021-08-20
CA Board of Psychology Consumer Statement-English (pdf)		2021-07-27
CA Board of Psychology Consumer Statement-Spanish (pdf)		2021-07-27
CA Board of Psychology Consumer Statement-Tagalog (pdf)		2021-07-27
CA Board of Psychology Consumer Statement-Vietnamese (pdf)		2021-07-27
MHP Beneficiary Handbook Cover in Threshold Languages (pdf)	Revised 07/10/2019	2021-07-19
SD Grievance-Appeal POSTER English LARGE FONT (pdf)	Revised 03/05/2019	2021-07-15
SD Grievance-Appeal POSTER Spanish (pdf)	Revised 03/06/2019	2021-07-15
SD Grievance-Appeal POSTER Arabic (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER English (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER Farsi (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER Tagalog (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER Vietnamese (pdf)	Revised 03/06/2019	2021-07-14
Beneficiary Non-Discrimination Notice - ENGLISH (pdf)		2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_ARABIC.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_FARSI.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_SPANISH.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_TAGALOG.docx	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_FARSI.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_SPANISH.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_TAGALOG.docx	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_VIETNAMESE.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_TAGALOG.docx	-	2018-08-07
Notice_of_Grievance_Resolution_-_SPANISH.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_FARSI.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_ENGLISH.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_ARABIC.doc	-	2018-08-07
Beneficiary Non-Discrimination Notice - ENGLISH (doc)		2018-08-07
NAR_Your_Rights_State_Hearing_-_VIETNAMESE.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_TAGALOG.docx	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_SPANISH.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_FARSI.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ENGLISH.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ARABIC.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_VIETNAMESE.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_ENGLISH.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_ARABIC.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_ENGLISH.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_VIETNAMESE.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_VIETNAMESE.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_TAGALOG.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_SPANISH.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_FARSI.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ENGLISH.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ARABIC.pdf	-	2018-08-07
Beneficiary_Non-Discrimination_Notice_-_VIETNAMESE.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_VIETNAMESE.doc		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_TAGALOG.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_TAGALOG.docx		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_SPANISH.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_SPANISH.doc		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_FARSI.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_FARSI.doc		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_ARABIC.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_ARABIC.doc		2018-08-06
Beneficiary Problem Resolution Process (doc)		2018-06-28
Notice of Privacy Practices - Farsi (pdf)		2018-02-13
NoticeofPrivacyPractices_Vietnamese_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_Tagalog_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_Spanish_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_English_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_Arabic_12-16-14.pdf		2017-02-06


2023-05-20-BHS Provider Memo-Payment Reform CPT for SMHS (pdf)		2023-06-06
2023-05-04 - BHS Contractor Memo-Open Payments Database (pdf)		2023-05-19
2023-04-20 – BHS Contractor Memo-TAY CANS (pdf)		2023-05-04
2023-05-01- BHS Contractor Memo- Open Payments Database (pdf)	Memo	2023-05-01
2023-02-22 – BHS Provider Memo – Screening and Transition Tool (docx)		2023-02-23
Revised 2023-2-8-BHS and Probation Care Coordination Directive_.pdf		2023-02-16
Day Treatment CalAIM and Contract Requirement Updates Memo 11.17.22 (docx)		2022-12-02
BHS Contractor Memo – CalAIM Documentation Reform (docx)	08/15/2022	2022-08-25
2022-06-21 – BHS Info Notice – Utilization Management (UM) Update (pdf)		2022-06-24
BHS Contractor Memo-CalAIM Documentation Reform	05/22/2022	2022-05-24
2022-02-11-BHS Contractor Memo-Medi-Cal RX Update dbc (docx)		2022-03-15
2021-11-10-BHS Contractor Memo-Medi-Cal RX 2021 (pdf)		2021-11-15
2021-06-29-BHS Information Notice-CYF Utilization Management Reinstated Effective 7.1.21 (pdf)	Effective July 1, 2021	2021-06-30
System of Care (SOC) Application - (BHS) – Contractor Information Notice (pdf)	11/23/2020	2020-11-30
Medication Assisted Treatment (MAT) Referrals (pdf)		2020-08-27
ASJ Memo 8-5-2020 (docx)		2020-08-05
ASJ Tip Sheet 8-5-2020 (docx)		2020-08-05
QM Memo ICD-10 7-16-20 (pdf)		2020-07-17
3/19/20 BHS Provider Notice #3- COVID 1- Quality Improvement Updates and Best Practices (pdf)		2020-03-20
QM Memo - EBP Indicator Removal for Homework & Child Family Team Meetings (docx)	Issued 02/06/2020	2020-02-07
QM MEMO - NOABD Logs (pdf)	Issued 01/31/2020	2020-01-31
QM MEMO - Medication Monitoring (pdf)	Issued 01/31/2020	2020-01-31
QIP Texting Presentation (pptx)		2020-01-21
CYF MEMO - Updated Ancillary SMHS Request Form (pdf)	Effective 1/1/2020	2020-01-10
CYF Memo Prior Auth for Day Services (pdf)	Effective 1-1-2020	2020-01-10
QM MEMO - CSI Diagnosis errors (pdf)	Issued 12/26/2019	2019-12-30
CYF MEMO - Utilization Management Outpatient Cycle Expansion (pdf)	Issued 12/20/2019	2019-12-30
QM Memo - DHCS Revised Telehealth Policies (docx)	Issued 12/06/2019	2019-12-09
QI - PIT MEMO - SOC Application (pdf)		2019-11-04
Optum San Diego Website MH Provider Registration Instructions (pdf)		2019-11-04
CYF MEMO – Revised UM Request Form (pdf)	Issued 09/03/2019	2019-09-06
CYF MEMO – IHBS Prior Authorization 08/16/19 (pdf)		2019-08-20
CYF Memo – TBS Prior Authorization Process (pdf)	Issued 7/29/19	2019-08-14
QM MEMO - New BHS 025 Forms (docx)		2019-04-24
QM MEMO - New Updated Discharge Form - 4.4.19 (pdf)		2019-04-12
CYF MEMO - Revised CANS Sharing Confirmation 3.26.19 (pdf)		2019-04-09
QM MEMO – PROSPECTIVE RISK ANALYSIS – 02.07.19 (docx)		2019-02-08
QM MEMO – PROSPECTIVE RISK ANALYSIS – 02.14.19 (doc)		2019-02-08
QM MEMO - Prospective Risk Analysis (docx)		2019-01-09
QM MEMO_-_New_Non-Bill_Other_Support_Service_Code_01_29_18.pdf		2018-11-29
QM MEMO - Patient_Advocacy Services for BHS - Record Requests 11 01 18 (pdf)		2018-10-31
QM MEMO - Privacy - Confidentiality Legislative Updates 10.23.18 (docx)		2018-10-24
QM MEMO_-_Specialty_Mental_Health_Service_Claiming_for_ES-HS_9_7_18.pdf		2018-10-08
Intensive_Service_Request_ISR_CYF_Memo_04-1617.pdf		2017-06-30
QM MEMO - Specialty Mental Health Service Claiming for ES-HS (pdf)		2018-09-10
QM MEMO – Billing for C-practitioners 07 02 18 (docx)		2018-07-13
QM MEMO – AOA Outpatient Utilization Management 06 29 18 (pdf)		2018-07-13
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_-_New_Auth_to_Use-Disclose_Multiple_Form_051513.pdf		2017-05-12
QM_MEMO_-_Client_Plan_Redesign_6-20-17.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_-_New_Evidence_Based_Practice_Indicators_06_23_17.pdf		2017-06-27
QM_MEMO_-_Allowed_Services_Prior_to_Client_Plan_Completion_-_DHCS_Guidelines_6_20_17.pdf		2017-06-21
QM Memo - New Billing Indicators - Intrepreter and Language 06-08-17 (pdf)		2017-06-14
QM_MEMO_-_Day_Treatment_Interim_Folder_03_29_17.pdf		2017-03-31
QM_MEMO_-_Place_of_Service_Update_03_30_17.pdf		2017-03-31
QM_MEMO_- 42_CFR_Final_Rule_1-26-17.pdf		2017-02-02
QI_MIS_MEMO_2016_12_01_CCBH_Client_Attachments.pdf		2018-05-25
QI_MIS_MEMO_2016_10_31_CCBH_Demographic_Form_Table_Change.docx		2016-11-03
QI_MIS_MEMO_2016_05_09_CCBH_Outside_of_the_Office_Update.pdf		2016-05-11
QM_MEMO_-_Day_Tx_Program_-_Updated_Standards.5.1.16.docx		2016-05-11
QI_MIS_MEMO_2015_11_20_Saving_Reports_to_a_SpreadsheetProcess_and Policy.pdf		2015-11-30
QM_MEMO_DHP_4_14.pdf		2015-10-09
QM_MEMO_-_Reaffirming_DHCS_Day_Treatment_Standards_08_26_14.docx		2015-10-09
QM_MEMO_-_New_Interactive_Add_On_Service_Code_785_9_22_14.docx		2015-10-09
QM_MEMO_-_Documentation_Guidelines_when_EHR_Unavailable_9_04_14.docx		2015-10-09
QM_Memo_-_90_Day_Lockout_Process_Update_11_06_13.pdf		2015-10-09
QI_MIS_MEMO_2014_1_09_Notifications_in_Anasazi.pdf		2016-05-16
FAQ_-_Request_for_Servcies_Log_-_Access_Time_Report_-_9-30-14_.pdf		2016-07-15
QM Memo - CPT Coding Changes 2013 (pdf)		2016-07-15
QM Memo - LPCC Credential Under MHP 07 24 13 (doc)		2015-10-09
QM Memo - Holder of Records 01 03 13 (pdf)		2016-07-15
CSI Requirement for MH Programs 08 27 12 (pdf)		2016-07-15


5150 Form (pdf)		2021-05-10
72 Hour Post Discharge Log (pdf)		2017-03-23
AOB - Arabic Version (docx)		2021-11-09
AOB - Arabic Version (pdf)		2021-11-05
AOB - English Version (docx)		2021-11-09
AOB - English Version (pdf)		2021-11-05
AOB - Spanish Version (docx)		2021-11-09
AOB - Spanish Version (pdf)		2021-11-05
AOB - Tagalog Version (docx)		2021-11-09
AOB - Tagalog Version (pdf)		2021-11-05
AOB - Vietnamese Version (docx)		2021-11-09
AOB - Vietnamese Version (pdf)		2021-11-05
Access to Services Log (xlsx)		2018-06-20
BHS 025 Form A (docx)	Revised 4/2021	2021-11-09
BHS 025 Form B (docx)	Revised 4/2021	2021-11-09
BHS Serious Incident Report (docx)	Revised 10/27/2022	2022-11-10
BHS Serious Incident Report Explanation (pdf)	Revised 07/01/2022	2022-07-01
BHS Serious Incident Report of Findings (docx)	Revised 07/07/2022	2022-07-22
BHS Serious Incident Report of Findings Explanation (pdf)	Revised 07/08/2022	2022-07-22
BHS-025 Form A and B Tip Sheet (docx)	Client Information - Revised 4/2019	2019-05-02
CCBH Void and Replace Form (xlsm)	Revised 10/04/2021	2021-10-07
Case Management Six Month Review Progress Note (pdf)		2017-03-23
Case Management UR Record (pdf)		2017-03-23
Case Management URC Minutes Form (pdf)		2017-03-23
DEMOGRAPHIC FORM FILL (docx)	Revised 06/01/2021	2021-05-28
DHCS 1739 Mental Health Professional Licensing Waiver Request (pdf)		2021-03-12
DPC 203 and 204 Forms (docx)		2023-02-07
Group Service Record (rtf)	Revised 08/2020	2020-08-07
HSD Medi-Cal Quick Guide Screening Tool (docx)		2021-12-13
Individual Service Record (doc)		2020-08-07
JV220(A) - Physician's Statement - Attachment (pdf)		2018-03-01
JV220(B) - Physican's Request to Continue Medication - Attachment (pdf)		2018-03-01
MAA Service Record (pdf)		2017-08-24
Med Mon McFloop Form (docx)	Revised 01/17/2020	2020-01-31
Med Monitoring Submission Form - Adult (xlsx)	Revised 01/12/2023	2023-01-13
Med Monitoring Submission Form - Childrens (xlsx)	Revised 04/24/2023	2023-04-28
Med Monitoring Tool AOA (docx)	Revised 10/26/2022	2022-10-26
Med Monitoring Tool CYF (docx)	Revised 10/26/2022	2022-12-09
Medi-Cal Administrative Activities (MAA) Procedures		2017-08-24
Medication Disposal Log (pdf)		2021-06-03
Mental Health Professional Licensing Waiver Request (pdf)	DHCS 1739 Revised 11/2021	2022-01-10
NVRA Voter Preferences Form-Arabic (pdf)		2021-03-12
NVRA Voter Preferences Form-English (pdf)		2021-03-12
NVRA Voter Preferences Form-Spanish (pdf)		2021-03-12
NVRA Voter Preferences Form-Tagalog (pdf)		2021-03-12
NVRA Voter Preferences Form-Vietnamese (pdf)		2021-03-12
NVRA_Voter_Preference_Form_Farsi.pdf		2017-09-14
New MRR Hybrid Chart and Program Compliance CHECKLIST (docx)	Revised 02/12/2021	2021-02-18
QIP Follow up Form FY 20-21 (docx)		2020-08-07
Reestablishment Recommendation Form (doc)		2021-03-12
Request for Verification of Veterans Eligibility (pdf)		2017-03-23
SERIOUS INCIDENT ROOT CAUSE ANALYSIS WORKSHEET (doc)	Revised 07/31/2012	2020-01-29
START TCC and URC Record (pdf)		2017-03-23
START URC Minutes Form (pdf)		2017-03-23
Service Authorization Request (pdf)		2021-03-12
Transition of Care Tool for Medi-Cal Mental Health Services (pdf)		2023-02-28
Transition of Care Tool for Medi-Cal Mental Health Services – Explanation Form (docx)		2023-02-28
Written Translation Service Authorization Form (pdf)		2021-03-12


01 - Cover Sheet Org Provider Manual (pdf )		2018-09-20
02 - Table of Contents Org Prov Op Handbook (pdf)	Revised 09/06/2022	2022-09-08
03 - OPOH - Customer Service Mission (pdf)	Revised 04/08/2020	2020-04-09
04 – OPOH – Section A – Systems of Care (pdf)	Revised 09/01/2022	2022-08-15
05 - OPOH - Section B - Compliance Confidentiality (pdf)	Revised 06/15/2021	2021-06-21
08 - OPOH - Section E - Integration With Physical Healthcare (pdf)	Revised 06/14/2021	2021-06-15
06 – OPOH – Section C – Accessing Services (pdf)	Revised 04/11/2023	2023-05-17
07 – OPOH – Section D – Providing Specialty Mental Health Services (pdf)	Revised 04/03/2023	2023-05-23
09 - OPOH - Section F - Beneficiary Rights Grievance Appeals (pdf)	Revised 05/31/2023	2023-06-05
10 - OPOH - Section G - Quality Improvement (pdf)	Revised 04/03/2023	2023-05-17
11 – OPOH – Section H – Cultural Competency (pdf)	Revised 09/06/2022	2022-09-08
12 - OPOH - Section I Management Info System (pdf)	Revised 02/21/2020	2020-03-02
13 - OPOH - Section J - Provider Contracting (pdf)	Revised 05/09/2023	2023-05-16
14 - OPOH - Section K - Provider Issue Resolution (pdf)	Revised 02/19/2020	2020-03-02
15 – OPOH – Section L – Practice Guidelines (pdf)	Revised 04/03/2023	2023-05-17
16 – OPOH – Section M – Staff Qualifications (pdf)	Revised 07/01/2022	2022-07-26
17 - OPOH - Section N - Data Requirements (pdf)	Revised 04/21/2023	2023-05-17
18 - OPOH - Section O - Training (pdf)	Revised 04/03/2023	2023-05-17
19 - OPOH - Section P - Mental Health Services Act (pdf)	Revised 03/11/2022	2022-03-17
20 – OPOH – Section Q – Payment Schedule and Budget Guidelines (pdf)	Revised 10/05/2021	2021-10-06
21 - OPOH - Section R - Quick_Reference (pdf)		2019-05-22


030 - OPOH - Appendix C - A.C.2 - AMHS - Walk-in Clinics Hours Contacts (pdf)		2019-07-18
031 - OPOH - Appendix C - A.C.3 - Transition Age Youth Referral Form (pdf)	Revised 04/15/2014	2016-07-13
032 - OPOH - Appendix C - A.C.4 - Transtion Age Youth Referral Plan 4-15-14 (pdf)	Revised 04/15/2014	2016-07-13
057 - OPOH - Appendix E - A.E.2 – HSD Plan Partner Card (pdf)		2020-02-20
058 - 00 - OPOH - Appendix E - A.E.3 - Plan Partner Identification for Pharmacies (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 - 01 - OPOH - Appendix L - A.L.1 - Monitoring Psychtropic Medications (pdf)	7-16-12	2016-07-13


EPSDT_TBS_Brochure_English.pdf		2016-07-15
EPSDT_TBS_Brochure_Spanish.pdf		2016-07-15
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
037_-_OPOH_-_Appendix_D_-_A.D.03_-_California_State_Penal_Institutions_List_.pdf		2017-03-23
QI_UPDATES_-_Annual_7_11_17 FINAL.pdf		2017-07-13
State_Health_Information_Guidance_-_December_2017.pdf		2017-12-18
Program_Provider_Numbers_List.pdf		2018-02-15
Travel_Time_Guidelines_Final_2-01-18.pdf		2018-02-15
FAQs from CPT Changes 2013 Webinar (pdf)		2016-07-15
Setting the Face Sheet to Display Instructions (doc)		2016-07-15
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
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
PWB Report Template Instructions (pdf)		2016-05-16
Payment Appilication Claims Report Instructions (pdf)		2016-05-16
Service_Date_Verification_Report.pdf		2016-05-16
BHS Quality Improvement 8th Annual Mental Health Providers Knowledge Forum - Presentation handout.pdf		2021-09-07
BHS Quality Improvement 8th Annual Mental Health Providers Knowledge Forum - Question-Answer Sheet.pdf		2021-09-07
MIS-25 Program Listing Report.xlsx		2023-05-04
3rd Party Suspense Report Instructions (ppt)		2019-04-10
7th Annual Mental Health Forum 9.22.20 - QA (docx)		2020-10-08
Abbreviation and Definitions List - BHS (doc)	Revised 11/30/2016	2016-11-30
Active Parolee Clients Report Instructions (docx)		2020-10-01
BHS Information Notice-Utilizing CANS Strengths in Therapy	03/09/2021	2021-03-10
BILLING LOCKOUT SETTINGS AND NON-REIMBURSABLE/REIMBURSABLE ACTIVITIES (pdf)		2022-06-06
CCBH Report Uses for Program Integrity (pdf)		2019-10-07
CPT Crosswalk (xlsb)	Revised 05/19/2023	2023-05-19
CSI Correction Guide – Full Version (pdf)		2021-01-29
CSI Correction Guide – Most Frequent Errors (pdf)		2021-01-29
Case Management versus Collateral (docx)		2021-03-15
Client Categories Maintenance (pdf)		2018-06-29
Client Categories – Parolee Tip Sheet (docx)		2020-07-31
Clinical Standard for Assessments (doc)		2018-06-15
Clinical Standards For Client Plans (pdf)	Updated 6/28/2019	2019-07-01
Crisis Intervention SC 70 Guideline (pdf)		2020-09-09
Denial Report Instructions (ppt)		2019-09-16
Diagnosis Practice Guidelines (pdf)	Updated 01/24/2022	2022-01-25
EM 102 CPT Coding Changes - 2013 (pdf)		2015-10-09
HOW Service Model Data Collection Flow (pdf)		2021-03-12
List of Controlled Substance 08.20.20 (pdf)		2020-09-01
MAA Procedures (pdf)		2021-03-12
MAA Service Record (pdf)		2021-03-12
MRR Tool – FY 22-23 (xlsx)	Revised 07/05/2022	2022-07-06
Medi-Cal Certification-Recertification Tool (xls)	FY 22-23	2022-04-07
Medi-Cal Rx Provider Registration and Training FAQs (pdf)		2021-12-16
Medi-Cal Rx Provider Training Checklist (pdf)	Revised 11/04/2021	2021-12-16
Medi-Cal Rx UAC Registration Quick Start Guide (pdf)		2021-12-16
Medical Necessity CalAIM Updates (docx)	Active 01/01/2022	2021-12-15
Medication Monitoring Process Flow Chart for Org Providers (pdf)		2021-04-27
Medication Services FAQ (docx)		2021-04-14
Mental Health Professional Licensure Waiver (pdf)		2021-01-06
New Contractor Orientation Resources (pdf)	Revised 04/07/2023	2023-04-10
Progress Note Checklist Table (pdf)	Checklist	2020-03-10
QI UPDATES MHP 7th ANNUAL 09.22.20 (pdf)		2020-10-08
QUALITY IMPROVEMENT KNOWLEDGE FORUM Presentation (pdf)	presented July 12, 2019	2019-07-18
Quality Improvement Annual Forum 2018 - Powerpoint (pptx)	07-25-2018 Presentation	2018-07-26
RCA WORKSHEET Sample (pdf)		2021-03-12
Reasons for Recoupment Changes Grid FY22-23 (docx)		2023-02-08
SOC Application - QIP Presentation (pdf)	Presented 10/22/19	2019-10-23
Service Code Approved Use Summaries -Appendix III (pdf)	Revised 09/26/2022	2022-10-05
Short-Doyle Medi-Cal (SDMC) Aid Code Master Chart (pdf)	Updated Aid Code Master Chart	2021-01-28
Telehealth Reminder Slides_QIP-July 2020 (pdf)	PowerPoint Presentation 10/22/2018	2020-07-29
Tip Sheet For Billable Services (docx)		2019-06-26
Transferring Clients Between Different Program Sites (docx)		2020-08-25
Transferring Clients Between Different Program Sites (docx)	Revised 05/05/2023	2023-05-09
Trauma-Informed Care Code of Conduct (pdf)		2019-06-17
Treatment Team Documentation Standards (pdf)		2018-09-11
Utilizing CANS Strengths in Therapy (pdf)	March 2021	2021-03-10
Who to Contact List (pdf)		2021-04-20


10 2018 PSC - Parent interactive (pdf)	Revised 3/2020	2020-03-26
10 2018 PSC - Youth Interactive (pdf)	Revised 3/2020	2020-03-26
ACKNOWLEDGEMENT NPP (docx)		2018-05-25
ADVANCE DIRECTIVE ADVISEMENT (doc)		2018-05-25
ADVANCE DIRECTIVE ADVISEMENT EXPLANATION (docx)		2018-05-25
AIMS FORM FILL (doc)		2018-02-13
ANCILLARY SMHS REQUEST - EXPLANATION (pdf)		2020-01-10
ANCILLARY SMHS REQUEST - FORM FILL (docx)		2020-01-10
AOA OUTPATIENT UM EXPLANATION FORM 1.31.19.docx	Revised 01/31/2019	2019-02-08
AOA OUTPATIENT UM FORM FILL (docx)		2019-02-08
AOA PATIENT MEDICATION AGREEMENT – EXPLANATION (docx)		2018-07-26
AOA Patient Medication Agreement English (pdf)		2018-06-08
AUTHORIZATION TO USE OR DISCLOSE PHI EXPLANATION (docx)		2018-02-09
Adult Clinical Record Chart Order (docx)	Revised 02/09/2023	2023-02-10
Authorization to Use or Disclose PHI (pdf)		2022-07-19
BHA – 0-5 FORMFILL (docx)	Revised 02/10/2023	2023-02-14
BHA – ADULT FORM FILL (doc)	Revised 02/10/2023	2023-02-14
BHA – CHILDREN FORM FILL (docx)	Revised 02/10/2023	2023-02-14
BHA – DEC FORM FILL (docx)	Revised 02/10/2023	2023-02-14
BHA – Explanation (docx)	Revised 07/27/2022	2022-07-28
CANS EXPLANATION (docx)	Revised 05/25/2021	2021-05-25
CANS Family Letter (pdf)		2019-03-29
CANS SHARING CONFIRMATION FORM FILL (docx)		2019-04-15
CANS Sharing Confirmation - Explanation Sheet (pdf)		2019-04-09
CANS Sharing Confirmation page - Client Plan (pdf)		2019-04-09
CASE MANAGEMENT PROGRESS NOTE FORM FILL (docx)	Revised 12/08/2020	2020-12-09
CLIENT ASSIGNMENT FORM (doc)		2018-08-14
CLIENT INFORMATION FACE SHEET EXPLANATION (docx)		2018-05-25
CLIENT PLAN SIGNATURE PAGE (docx)		2019-07-03
CONSENT FOR SERVICES (docx)	Revised 01/31/2023	2023-03-14
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
CRISIS STABILIZATION UNIT DAILY DOCUMENTATION PROGRESS NOTE (docx)	Revised 06/11/2021	2021-06-24
CRISIS STABILIZATION UNIT DISCHARGE PROGRESS NOTE (docx)	Revised 06/11/2021	2021-06-24
CRISIS STABILIZATION UNIT REASSESSMENT PROGRESS NOTE (docx)	Revised 06/11/2021	2021-06-24
CSU EPISODE SUMMARY (docx)		2023-03-29
CSU EPISODE SUMMARY – EXPLANATION (docx)		2023-03-29
Case Management-Peer Support CP PN Form Fill (docx)	Revised 08/26/2022	2022-08-25
Case Management-Peer Support MHSA CP Explanation Sheet (docx)	Revised 05/03/2023	2023-05-04
Children’s Uniform Chart Order (docx)	Revised 02/09/2023	2023-02-10
Client Plan Explanation (docx)	Revised 10/07/2022	2022-10-10
Client Plan Form Fill (docx)	Revised 10/07/2022	2022-10-10
Consent for Services (docx)	Revised 01/31/2023	2023-02-08
DAY TREATMENT CLIENT PLAN (doc)		2017-02-17
DAY TREATMENT WEEKLY SUMMARY (doc)		2020-01-22
DAY TREATMENT WEEKLY SUMMARY INSTRUCTIONS (docx)		2020-01-22
DEMOGRAPHIC FORM EXPLANATION (docx)	Revised 05/2021	2021-05-20
DEMOGRAPHIC FORM FILL (docx)	Revised 09/22/2022	2023-02-17
DIAGNOSIS FORM (docx)		2018-02-13
DIAGNOSIS FORM EXPLANATION (docx)	Revised 05/26/2021	2021-05-26
DISCHARGE SUMMARY EXPLANATION (docx)	Revised 12/2022	2022-12-27
DISCHARGE SUMMARY FORMFILL (docx)	Revised 02/10/2023	2023-02-14
DISCHARGE SUMMARY PAPER FORM INSTRUCTIONS (doc)	Uploaded 07-05-2019	2019-07-05
Daily Progress Note (docx)		2023-01-05
Daily Progress Note Explanation Sheet (docx)		2023-01-05
ECBI EXPLANATION (docx)		2018-05-25
ESU NURSING NOTE FORM FILL (docx)		2020-08-17
Explanation for Eligibility Form (pdf)		2017-10-25
General Progress Note (docx)	Revised 08/26/2022	2022-08-25
General Progress Note Explanation Sheet (docx)	Revised 08/25/2022	2022-10-06
Group Progress Note (docx)		2023-01-05
Group Progress Note Explanation Sheet (docx)		2023-01-05
HIGH RISK ASSESSMENT EXPLANATION (docx)	Revised 05/2021	2021-05-20
HIGH RISK ASSESSMENT FORM FILL (docx)		2018-05-25
HIGH RISK INDEX FORM FILL (docx)		2018-05-25
IHBS AUTHORIZATION REQUEST – EXPLANATION (docx)	Revised 04/01/2022	2022-03-25
IHBS PRIOR AUTHORIZATION REQUEST FORM FILL (docx)	Revised 04/01/2022	2022-03-25
IMR ADULT OUTCOMES EXPLANATION (docx)		2018-02-13
IMR CLINICIAN ASSESSMENT FORM (pdf)		2021-02-02
INFORMED CONSENT PSYCHOTROPIC MEDICATION ENGLISH (docx)		2021-03-05
INFORMED CONSENT PSYCHOTROPIC MEDS EXPLANATION (docx)		2023-05-23
INITIAL SCREENING FORMFILL (docx)	Revised 02/10/2023	2023-02-14
INITIAL SCREENING PAPER FORM INSTRUCTIONS (doc)	Revised 02/10/2023	2023-02-14
INITIAL SCREENING PERT FORMFILL (docx)	Revised 02/10/2023	2023-02-14
INITIAL SCREENING PERT PAPER FORM INSTRUCTIONS (docx)	Revised 02/10/2023	2023-02-14
LOCUS ADULT OUTCOMES EXPLANATION (docx)		2018-02-13
LOCUS Instrument Version 20 (pdf)	Adult Version 20, December 2016	2019-06-28
MCRT ASSESSMENT (docx)	Revised 11/02/2021	2022-01-25
MEDICAL CONDITION REVIEW EXPLANATION (docx)		2018-05-25
MEDICAL CONDITION REVIEW FORM EHR (docx)		2018-05-25
MEDICATION PROGRESS NOTE SC28 (docx)	Uploaded 07-05-2019	2019-07-05
MEDS MANAGEMENT LONG NOTE FORM FILL (doc)		2020-08-07
MOBILE CRISIS ASSESSMENT (docx)		2023-05-30
MORS ADULT OUTCOME EXPLANATION (docx)		2018-02-13
MORS ADULT OUTCOME MEASURE (docx)		2018-05-25
MY SAFETY PLAN EXPLANATION (docx)		2018-06-21
MY SAFETY PLAN FORM FILL - ENGLISH (docx)	Revised 04/29/2022	2022-05-03
Medication Progress Note SC24 (docx)		2020-08-07
Medication Progress Note SC25 (docx)		2020-08-07
Medication Progress Note SC26 (docx)		2020-08-07
Medication Progress Note SC27 (docx)		2020-08-07
Medication Progress Note SC28 (docx)		2020-08-07
NEVER BILLABLE PROGRESS NOTE FORM FILL (doc)		2020-03-18
NURSING NOTE FORM FILL (docx)		2020-09-17
PRIOR AUTHORIZATION DAY SERVICES REQUEST (docx)	Revised 04/01/2022	2022-03-25
PRIOR AUTHORIZATION DAY SERVICES REQUEST – EXPLANATION (docx)		2022-06-13
PROSPECTIVE RISK ANALYSIS (PRA) (docx)	Revised 05/2021	2021-05-28
PROSPECTIVE RISK ANALYSIS PRA EXPLANATION (docx)	Revised 05/2021	2021-05-20
PSC-35 Explanation (docx)	Revised 08/20/2021	2021-08-20
PSYCHIATRIC ASSESSMENT EHR EXPLANATION (docx)		2019-12-12
PSYCHIATRIC ASSESSMENT FORM FILL (doc)		2018-02-13
PSYCHIATRIC ASSESSMENT PAPER FORM INSTRUCTIONS (doc)		2017-02-17
Problem List - FormFill (docx)	Revised 08/29/2022	2022-08-25
Problem List Explanation (docx)	Revised 08/26/2022	2022-08-25
RELEASE OF INFORMATION CHILD 04-24A-P (dot)		2017-02-17
REQUEST FOR ACCESS COPY OF PHI (doc)		2017-02-17
RMQ QUESTIONNAIRE FORM (pdf)		2021-01-22
RMQ QUESTIONNAIRE FORM (pdf)		2021-02-02
Recovery Markers Questionnaire Form 093009 (pdf)		2020-07-14
SAFETY ALERT PAPER FORM INSTRUCTIONS (doc)		2017-03-02
SAFETY ALERTS EXPLANATION (docx)		2018-05-25
SAFETY ALERTS FORM FILL (doc)		2018-02-13
SATS-R ADULT OUTCOME EXPLANATION (docx)		2018-02-13
SATS-R FORM 2 (doc)		2017-03-02
SD-CANS Explanation (docx)	Revised 05/14/2021	2021-10-26
STRENGTHS TABLE (docx)		2018-05-25
Service Indicator Outside Facility ID Listing (xlsx)	Revised 03/2023	2023-03-30
Service Indicator Table Key (docx)		2020-03-18
TIERS ABUSE ADDICTION (docx)		2018-05-25
TIERS BASIC NEEDS (docx)		2018-05-25
TIERS EDUCATION (docx)		2018-05-25
TIERS EMOTIONAL BEHAVIORAL PSYCHIATRIC (docx)		2018-02-09
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
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
UM Request Explanation Sheet (docx)	Revised 07/01/2022	2022-06-21
UM Request Form (pdf)	Revised 07/01/2022	2023-05-08
VITALS FORM FILL (doc)		2017-03-02
WALK IN ASSESSMENT PROGRESS NOTE FORM FILL (doc)		2020-08-07
WRAPAROUND PROGRESS NOTE FORM FILL (doc)		2018-07-24
WRAPAROUND PROGRESS NOTE FORM FILL (doc)		2020-08-10
YOUTH TRANSITION SELF EVALUATION EXPLANATION (docx)		2021-08-20
Youth Transition Self Evaluation Formfill (docx)		2020-06-18


1 – SUDPOH (pdf)	Revised 03/20/2023	2023-03-22
2 – Summary of Changes (pdf)	Revised 03/20/2023	2023-03-22


602a_Instructions_SUD_Peer_Plan_of_Care_Progress_Note_08-2022.pdf		2022-08-18
00 – SUD Uniform Record Manual 07-01-19 (pdf)		2019-09-03
01 – Uniform Record Manual 07-01-19 (pdf)	Revised July 2019	2019-07-31
02 - Client File Order (pdf)	Revised December 2020	2020-12-23
03 - Section 1 Detail 01-14-19 (pdf)		2019-02-11
101a Instruction Client Tracking (pdf)	Revised December 2020	2020-12-23
101b Client Tracking (pdf)	Revised December 2020	2020-12-23
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 Screening Tool (pdf)	Revised August 2022	2022-08-12
104b-2 Brief Level of Care Screening Tool (pdf)	Revised August 2022	2022-08-12
104d-1 Instructions Adolescent Initial Level of Care Assessment (pdf)	Revised 09/2022	2022-10-10
104d-2 Adolescent Initial LOC Assessment Hard Copy (pdf)		2022-10-10
104d-3 Adolescent Initial LOC Assessment Form (pdf)	Revised December 2020	2021-02-10
104e-1 Instructions Parent Guardian Initial Level of Care Assessment (pdf)	Revised December 2020	2020-12-23
104e-2 Parent Guardian Initial LOC Assessment Hard Copy (pdf)	Revised December 2020	2020-12-23
104e-3 Parent Guardian Initial LOC Assessment Form Fill (pdf)	Revised December 2020	2020-12-23
105 Placement Fee Collection 4-12-17 (pdf)		2017-05-01
105a Instructions Adult ASAM Criteria Assessment (pdf)	Revised August 2022	2022-08-12
105b ASAM Criteria Assessment (pdf)	August 2022	2023-03-07
106 Placement-ID-SS-Medi Cal Cards (pdf)		2018-07-06
107a Instruction Financial Responsibility Info and MC SOC 05-01-2020 (pdf)	Revised May 2020	2020-05-14
107b Financial Responsibility Information and MC SOC 05-01-2020 (pdf)	Revised May 2020	2020-05-14
108 Placement - SanWITS Admission Profile 01-14-19 (pdf)		2019-02-11
200 Section 2 Detail 07-01-19 (pdf)		2019-07-26
201 Placement-consent to release 07-01-19 (pdf)		2019-07-26
202 Placement-Admissions Agreement-Consent to Treatment 4-12-17 (pdf)		2017-05-01
203a Instructions Client Rights and Complaints 05-01-2020 (pdf)	Revised May 2020	2020-05-14
203b Client Rights and Complaints (pdf)	Revised December 2020	2020-12-23
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
209a Instruction Acknowledgement of DMC-ODS Handbook Practice Guidelines and Provider Directory 03-07-19 (pdf)		2019-03-21
209b Acknowledgement of DMC-ODS Handbook Practice Guidelines and Provider Directory (pdf)		2021-02-09
210a Instructions SUD Program Admission Checklist 6-27-18 (pdf)		2018-07-06
210b SUD Program Admission Checklist (pdf)	Revised November 2022	2022-11-11
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
303d YAI (pdf)		2018-09-11
304a Instruction Co-occurring Form 4-12-17 (pdf)		2017-05-01
304b Co-occurring Screening Form 4-12-17 (pdf)		2017-04-27
304c Form Fill Co-occurring Screening Form 4-12-17 (doc)		2017-04-27
305a-1 Instruction Risk Assessment and Safety Management Plan 06-06-19 (pdf)	Revised 06-06-19	2019-07-22
305a-2 Risk Assessment and Safety Management Plan 06-06-19 (pdf)		2019-07-22
305b-1 Instruction High Risk Assessment 06-06-19 (pdf)	Revised 06-06-19	2019-07-22
305b-2 High Risk Assessment 06-06-19 (pdf)		2019-07-22
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
400 Section 4 Detail 01-14-19 (pdf)		2019-02-11
401a Instruction WM Observation Log 11-26-19 (pdf)		2019-12-02
401b Withdrawal Observation Log 11-21-19 (pdf)		2019-12-02
402a Instruction Centrally Stored Medication & Destruction Record 4-12-17 (pdf)		2018-07-06
402b Centrally Stored Medication and Destruction Record (pdf)		2017-04-27
403 Placement – Health Questionnaire 07-07-2022 (pdf)		2022-08-02
404a Instruction TB questionnaire 01-11-19 (pdf)		2019-02-11
404b TB screening form 4-12-17 (pdf)		2017-05-01
406 Instruction Physician Direction Form (pdf)	Revised 2022	2022-10-10
406 Physician Direction Form 09-2022 (pdf)	Revised 09/2022	2022-10-10
407 MD Recomendation to client 4-12-17 (pdf)		2017-05-01
407a Placement - Physical Exam Results 05-01-2020 (pdf)	Revised May 2020	2020-05-14
408 Placement - Proof of Pregnancy 01-11-19 (pdf)		2019-02-11
500 Section 5 Detail 01-14-19 (pdf)		2019-02-11
501a Instructions Problem List (pdf)	Revised August 2022	2022-08-12
501b Problem List (pdf)	Revised August 2022	2022-08-12
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
601a Instructions SUD Treatment Progress Note (pdf)	Revised August 2022	2022-08-12
601b SUD Treatment Progress Note 08-2022 (pdf)	Revised August 2022	2022-09-22
602b Peer Support Services Plan of Care (pdf)	Revised 08/2022	2022-09-19
605a Instructions Other Progress Note (pdf)	Revised December 2020	2020-12-23
605b Other Progress Note (pdf)	Revised December 2020	2020-12-23
605c Other Progress Note - Form Fill 12-01-2020 (pdf)	Revised December 2020	2021-01-28
700 Section 7 Detail 01-15-19 (pdf)		2019-02-11
701a Instructions Discharge Summary (pdf)	Revised October 2021	2021-11-03
701b Discharge Summary - Hard Copy (pdf)	Revised October 2021	2021-11-03
701c Discharge Summary - Form Fill (pdf)	Revised October 2021	2021-11-03
703 Placement - SanWITS Discharge Profile 01-14-19 (pdf)		2019-02-11
704a Instruction Client Discharge Plan (pdf)	Revised October 2021	2021-11-03
704b Client Discharge Plan - Hard Copy (pdf)	Revised October 2021	2021-11-03
704c Client Discharge Plan - Form Fill (pdf)	Revised October 2021	2021-11-03
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
807 Placement - SanWITS Residential Authorization Printout (pdf)		2019-02-11
ADOLESCENT RSUD AUTH REQUEST FAX COVER SHEET (docx)	Revised 09/01/2022	2022-09-02
ADOLESCENT RSUD AUTH REQUEST FAX COVER SHEET (pdf)	Revised 09/01/2022	2022-09-02
ADULT RSUD AUTH REQUEST FAX COVER SHEET (docx)	Revised 09/01/2022	2022-09-02
ADULT RSUD AUTH REQUEST FAX COVER SHEET (pdf)	Revised 09/01/2022	2022-09-02
SUD Residential Authorization Request (pdf)	Revised 09/01/2022	2022-09-02
SUD Residential Authorization Request (pdf)	Revised 09/01/2022	2022-09-02


BHS Inventory Form (xlsx)		2021-06-24
DPC 203 and 204 Forms (docx)		2023-02-07
Gift Card Approval Form (xlsx)		2021-06-24
PWD Accessibility Assessment (docx)		2022-11-08
PWD Program Referral List (pdf)	Updated 9/30/2021	2022-11-08
Root Cause Analysis Worksheet (doc)		2021-06-24
SUD Complaint Form (docx)		2021-06-24
Serious Incident Report (docx)	Revised 10/27/2022	2022-11-02
Serious Incident Report - Explanation (pdf)		2022-07-07
Serious Incident Report of Findings (docx)	Revised 07/07/2022	2022-07-12
Serious Incident Report of Findings Explanation (pdf)		2022-07-14


Info Notice – Payment Reform CPT Crosswalk (pdf)	May 15, 2023	2023-05-31
Info Notice – Open Payments Database (pdf)	05/04/2023	2023-05-19
Out-of-Network Claims Process for Indian Health Care Providers (pdf)	Revised 04/03/2023	2023-04-11
Residential OOC Medi-Cal Tip Sheet (pdf)	Revised 03/20/2023	2023-03-23
Outpatient OOC Medi-Cal Tip Sheet (pdf)	Revised 03/20/2023	2023-03-23
OTP OOC Medi-Cal Tip Sheet (pdf)	Revised 03/20/2023	2023-03-23
BHS Info Notice-DMC Process for Out-of-County Clients (pdf)	03/22/2023	2023-03-23
DMC Flowchart for Out-of-County Clients (pdf)	03/20/2023	2023-03-23
BHS and Probation Care Coordination Directive (pdf)	Revised 02/08/2023	2023-02-16
Info Notice – Documentation Reform Implementation Update (pdf)	Revised 08/15/2022	2022-08-18
00 – Archived List – Communications (pdf)	Revised 10/06/2022	2022-10-12
CYF Memo – DMC-ODS Updated Guidance for TRC Sites (pdf)	January 18, 2019	2022-10-06
Info Notice – CalAIM Documentation Reform BHS Plan	6/14/22	2022-06-24
Info Notice – New Program Enrollment – Before Admission/After Discharge (pdf)	6/23/22	2022-06-24
ACO Tip Sheet – 42 CFR Changes (pdf)	Effective 08/14/2020	2021-06-24
01 - Compliance Bulletin #30 - Cloned Documentation - 11-1017 (pdf)	2011 10/17 Issued	2018-12-06
System of Care (SOC) Application - (BHS) – Contractor Information Notice (pdf)	11/23/2020	2020-11-30
DHCS Medi-Cal Rx Website and Pharmacy Portal Policy (pdf)	08/14/2020	2020-10-22
DHCS Medi-Cal Rx FAQ (pdf)	06/30/2020	2020-10-22
Info Notice - Medi-Cal Rx Prescriber and Pharmacy Provider Registration and Training (pdf)	10/21/2020	2020-10-22
QM Memo – State Fair Hearing COVID Waiver (pdf)	04/16/2020	2020-05-12
3/19/20 BHS Provider Notice #3- COVID 19- Quality Improvement Updates and Best Practices (pdf)		2020-03-20
QM Memo – DSM 5 Diagnoses in SanWITS (pdf)	Issued 01/22/2020	2020-01-27
Info Notice – BHS 2020-002 - DMC-ODS Clients with Other Health Coverage (pdf)	Issued 01/15/2020	2020-01-16
Info Notice - BHS 2020-002 Assign Insurance Benefits Form (pdf)	Revised 05/20/2019	2020-01-16
Memo – DMC-ODS Travel Time Guidelines (pdf)	Updated 10-21-19	2019-10-22
Email – SUD Providers – Requirements for Policy and Procedure Development Monitoring (pdf)	2018 02/23 Emailed	2019-10-10
QM Memo - Physical Exam Requirements (pdf)	2019 10/02 Issued	2019-10-03
QM Memo - Residential Authorization Request Timelines	2019 08/05 Issued	2019-08-12
Info Notice - DMC-ODS FY 18-19 Data Entry Requirements	06/28/2019	2019-07-18
Info Notice – Share of Cost Process (pdf)	2019 02/01 Issued	2019-02-06
Memo – Patient Advocacy Services for BHS – Record Requests (pdf)	2018 10/31 Emailed	2018-11-02
Memo – Assessed No Admit and Assess Delayed Admit 10-18 (pdf)	2018 10/19 Issued	2018-10-26
Info Notice – BHS 2018-014 Timely Admissions for Collaborative Court Participants (pdf)	2018 10/19 Issued	2018-10-26
Email - BHS 2018-014: Timely Admissions for Collaborative Court Participants (pdf)	2018 10/12 Emailed	2018-10-19
Info Notice - Timely Access to Services (pdf)	2018 07/31 Issued	2018-08-06
Info Notice - Process for Out-of-County Clients (pdf)	2018 07/30 Issued	2018-08-06
Info_Notice_-_Reentry_and_Drug_Courts_SUD_Treatment_Services.pdf	2018 06/13 Issued	2018-06-15
Info_Notice_-_DMC-ODS_Court_Ordered_Residential_Treatment_-_Follow-Up.pdf	2018 06/12 Issued	2018-06-12
Info_Notice_-_DMC-ODS_Training_Requirements_and_Waiver_Resources.pdf	2018 03/19 Issued	2018-06-06
Info_Notice_-_DMC-ODS_Court_Ordered_Residential_Treatment.pdf	2018 05/17 Issued	2018-06-06


00 - Archived List - QM Training (pdf)	Updated 09/01/2022	2022-09-02
01 – Annual DMC-ODS Training (pdf)	Revised 08/18/2022	2022-10-06
06 - DMC-ODS New Training Requirements FY 22-23 (pdf)		2022-10-21
02 – Program Integrity Webinar (pdf)	Revised April 2021	2023-05-11
03 – Beneficiary Rights Webinar (pdf)	Revised 06/04/2019	2023-05-11
04 – Substance Use Disorder PRIVACY RULES 2022		2022-02-22
05 – CalMHSA Learning Management System Instructions (pdf)		2022-07-20
07 – How to Access RIHS Trainings (pdf)		2022-11-08


County of San Diego DMC-ODS Implementation Plan.pdf		2018-09-13
County of San Diego DMC-ODS Implentation Plan Appendix.pdf		2018-09-13
00 – Archived List - Manuals (pdf)	Updated 06/30/2021	2021-07-02
00 – Archived List – Manuals (pdf)	Updated 05/09/2024	2024-05-09
CalMHSA Clinical Documentation Manual (pdf)	Revised 06/03/2022	2022-06-10
County of San Diego DMC-ODS Intergovernmental Agreement FY 2020-2023 (pdf)		2021-06-29
County of San Diego DMC-ODS Intergovernmental Agreement FY 2023-2027 (pdf)		2024-05-09
DHCS AOD Program Certification Standards (pdf)	February 2020	2020-08-26
DHCS Adolescent SUD Best Practices Guide (pdf)	October 2020	2022-08-02
DHCS Perinatal Practice Guidelines (pdf)		2020-07-17
DMC - ODS Provider Services Guide	Updated 10/26/2020	2020-11-03
DMC - ODS Provider Services Guide (Summary of Changes)	October 2020	2020-11-03
SABG Enclosure 2 Program Specifications (pdf)		2022-02-09
Special Terms and Conditions (pdf)	Amended 12/29/2020	2021-05-21


One-Pager_-_DMC-ODS_Required_Policies_and_Procedures.pdf	Updated Jun 8 2018	2018-06-12
One-Pager_-_Programs_with_Multiple_Contracts.pdf	Updated May 14 2018	2018-06-15
Group Participation List (pdf)	Updated 09/2023	2023-04-20
00 – Archived List – Toolbox (pdf)	Revised 03/08/2022	2022-03-09
ASAM Level of Care Guidelines (pdf)		2018-11-08
CDC Effects of Tobacco on Mental Health and Substance Use		2022-07-21
CPT Crosswalk for DMC-ODS (xlsb)	Revised 05/15/2023	2023-05-19
CRAFFT Questionnaire (TRC Only) (pdf)		2021-07-29
DHCS Toolkit – MAT in Residential Treatment Facilities (pdf)		2020-09-21
DMC-ODS SUD Provider Operations Resource Guide (pdf)	Updated December 2020	2020-12-16
Diagnosis Determination Tool (pdf)	Revised 09/2022	2023-01-27
IHCP Referral Resource (pdf)		2023-04-21
In-custody SUD Tx Self-Referral form 10-16-18 (pdf)		2018-10-26
MAT Education	Uploaded 06/08/2021	2021-06-08
One-Pager DMC-ODS Documentation Changes (pdf)	Updated Jun 18 2018	2018-06-20
One-Pager – Care Coordination in the DMC-ODS (pdf)	September 14, 2022	2022-10-26
One-Pager – Tobacco Cessation Resources		2022-07-21
Opioid Treatment Program Guidelines (pdf)	Updated 05/14/2021	2021-05-21
Outpatient Due Date Timelines – Leap Year (pdf)		2022-12-13
Outpatient Due Date Timelines – Standard Year (pdf)		2022-12-13
Priority SDOH Codes on Problem Lists (pdf)		2022-08-02
Quick Guide - DMC-ODS Client Flow Process (pdf)		2018-09-10
Quick Guide - Residential Due Dates (pdf)		2018-08-10
Quick Guide - Same Day Billing Matrix (pdf)	Updated Jun 19 2018	2018-06-22
Quick Guide – Care Coordination Activities (pdf)	September 2022	2022-10-26
Quick Guide – DSM5-ICD10 Diagnosis Guide (pdf)	Updated 10/20/22	2022-11-08
Quick Guide – EPSDT 0.5 Workflow (pdf)		2023-02-03
Quick Guide – Minimum Quality Drug Treatment Standards for DMC/SABG (pdf)		2022-10-26
Quick Guide – Residential Services (pdf)	Updated 10/27/2022	2023-02-14
Quick Guide – SUD Residential Clinical Documentation and Authorization (pdf)	Revised September 2022	2022-10-26
RS Enrollment in a Different Program (pdf)	09/09/2022	2022-09-14
RS Enrollment with No Prior Enrollment (pdf)	09/09/2022	2022-09-14
RS Enrollment within the Same Program (pdf)	09/09/2022	2022-09-14
Residential Due Date Timelines – Leap Year (pdf)		2022-12-13
Residential Due Date Timelines – Standard Year (pdf)		2022-12-13
Residential Due Date Timelines – Standard Year Immediately Preceding Leap Year (pdf)		2022-12-13
Residential Weekly Services Log Tool (pdf)	Revised 09/2022	2023-01-27
Transportation Guidelines (pdf)	Updated 10-25-19	2019-10-28
Withdrawal Management Standards (pdf)	Revised 06/04/2020	2020-11-25


DMC-ODS Beneficiary Handbook February 2023_Spanish.pdf	Effective 03/12/2023	2023-03-10
DMC-ODS Beneficiary Handbook February 2023_Vietnamese.pdf	Effective 03/12/2023	2023-03-10
DMC-ODS Beneficiary Handbook February 2023_Tagalog.pdf	Effective 03/12/2023	2023-03-10
DMC-ODS Beneficiary Handbook February 2023_Farsi.pdf	Effective 03/12/2023	2023-03-10
DMC-ODS Beneficiary Handbook February 2023_Korean.pdf	Effective 03/12/2023	2023-03-10
DMC-ODS Beneficiary Handbook February 2023_Dari.pdf	Effective 03/12/2023	2023-03-10
DMC-ODS Beneficiary Handbook February 2023_Chinese (Trad).pdf	Effective 03/12/2023	2023-03-10
DMC-ODS Beneficiary Handbook February 2023_Somali.pdf	Effective 03/12/2023	2023-03-10
DMC-ODS Beneficiary Handbook February 2023_Arabic.pdf	Effective 03/12/2023	2023-03-10


Audio__Quick__Guide__-__DMC-ODS__Services__in__San__Diego__-__Arabic.mp3	For use after Jul 1 2018	2018-06-20
Audio__Quick__Guide__-__DMC-ODS__Services__in__San__Diego__-__English.mp3	For use after Jul 1 2018	2018-06-20
Audio__Quick__Guide__-__DMC-ODS__Services__in__San__Diego__-__Farsi.mp3	For use after Jul 1 2018	2018-06-20
Audio__Quick__Guide__-__DMC-ODS__Services__in__San__Diego__-__Spanish.mp3	For use after Jul 1 2018	2018-06-20
Audio__Quick__Guide__-__DMC-ODS__Services__in__San__Diego__-__Tagalog.mp3	For use after Jul 1 2018	2018-06-20
Audio__Quick__Guide__-__DMC-ODS__Services__in__San__Diego__-__Vietnamese.mp3	For use after Jul 1 2018	2018-06-20
Brochure_-_Grievance_and_Appeal_Process_-_English.pdf	For use after Jul 1 2018	2018-06-29
02 – DMC-ODS Beneficiary Handbook Summary of Changes (pdf)	Revised 02/06/2023	2023-02-07
00 – Archived List – Beneficiary (pdf)	February 9, 2021	2021-02-10
01 - DMC-ODS Beneficiary Packet Materials Order Form 05-09-19 (pdf)		2019-05-13
Advance Directive - Dari (pdf)		2023-05-04
Advance Directive - Farsi (pdf)		2023-05-04
Advance Directive - Korean (pdf)		2023-05-04
Advance Directive – Arabic (pdf)		2023-05-04
Advance Directive – Chinese (Traditional) (pdf)		2023-05-04
Advance Directive – English (pdf)		2023-05-04
Advance Directive – Somali (pdf)		2023-05-04
Advance Directive – Spanish (pdf)		2023-05-04
Advance Directive – Tagalog (pdf)		2023-05-04
Advance Directive – Vietnamese (pdf)		2023-05-04
Brochure – Grievance and Appeal Process 6-28-18 Arabic (pdf)		2018-08-15
Brochure – Grievance and Appeal Process 6-28-18 Farsi (pdf)		2018-08-15
Brochure – Grievance and Appeal Process 6-28-18 Spanish (pdf)		2018-08-15
Brochure – Grievance and Appeal Process 6-28-18 Tagalog (pdf)		2018-08-15
Brochure – Grievance and Appeal Process 6-28-18 Vietnamese (pdf)		2018-08-15
Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Arabic (docx)		2018-08-15
Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 English (docx)		2018-06-29
Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Farsi (docx)		2018-08-15
Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Spanish (docx)		2018-08-15
Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Tagalog (docx)		2018-08-15
Form – Client Grievance or Appeal – CCHEA Outpatient 6-28-18 Vietnamese (docx)		2018-08-15
Form – Client Grievance or Appeal – JFS Residential 6-28-18 Arabic (docx)		2018-08-15
Form – Client Grievance or Appeal – JFS Residential 6-28-18 English (docx)	For use after Jul 1 2018	2018-06-29
Form – Client Grievance or Appeal – JFS Residential 6-28-18 Farsi (docx)		2018-08-15
Form – Client Grievance or Appeal – JFS Residential 6-28-18 Spanish (docx)		2018-08-15
Form – Client Grievance or Appeal – JFS Residential 6-28-18 Tagalog (docx)		2018-08-15
Form – Client Grievance or Appeal – JFS Residential 6-28-18 Vietnamese (docx)		2018-08-15
Limited English Proficiency Poster – Arabic (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Chinese (Traditional)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Dari (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – English (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Farsi (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Korean (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Somali (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Spanish (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Tagalog (pdf)	Revised 04/2023	2023-05-02
Limited English Proficiency Poster – Vietnamese (pdf)	Revised 04/2023	2023-05-02
Open Payments Database Notification to Clients (pdf)		2023-05-26
Poster – Grievance and Appeal 03-06-19 Arabic (pdf)		2020-03-12
Poster – Grievance and Appeal 03-06-19 English (pdf)		2020-03-12
Poster – Grievance and Appeal 03-06-19 Farsi (pdf)		2020-03-12
Poster – Grievance and Appeal 03-06-19 Spanish (pdf)		2020-03-12
Poster – Grievance and Appeal 03-06-19 Tagalog (pdf)		2020-03-12
Poster – Grievance and Appeal 03-06-19 Vietnamese (pdf)		2020-03-12
Poster – Grievance and Appeal English LARGE FONT 03-05-19 (pdf)		2020-03-12
Quick Guide - How To Apply for Medi-Cal (pdf)		2018-11-27
Quick Guide – DMC-ODS Services in San Diego - Arabic (pdf)	Updated 03-04-2019	2019-03-05
Quick Guide – DMC-ODS Services in San Diego - English (pdf)	Updated 03-04-2019	2019-03-05
Quick Guide – DMC-ODS Services in San Diego - Farsi (pdf)	Updated 03-04-2019	2019-03-05
Quick Guide – DMC-ODS Services in San Diego - Spanish (pdf)	Updated 03-04-2019	2019-03-05
Quick Guide – DMC-ODS Services in San Diego - Tagalog (pdf)	Updated 03-04-2019	2019-03-05
Quick Guide – DMC-ODS Services in San Diego - Vietnamese (pdf)	Updated 03-04-2019	2019-03-05


SUD Up to the Minute – May 2023 (pdf)	2022 - 2023	2023-05-23
SUD Up to the Minute – April 2023 (pdf)	2022 - 2023	2023-04-13
SUD Up to the Minute – March 2023 (pdf)	2022 - 2023	2023-04-13
SUD Up to the Minute – February 2023 (pdf)	2022 - 2023	2023-02-10
SUD Up to the Minute – January 2023 (pdf)	2022 - 2023	2023-01-13
SUD Up to the Minute – December 2022 (pdf)	2022 - 2023	2022-12-13
SUD Up to the Minute – November 2022 (pdf)	2022 - 2023	2022-11-11
SUD Up to the Minute - October 2022 (pdf)	2022 - 2023	2022-10-19
SUD Up to the Minute - September 2022 (pdf)	2022 - 2023	2022-09-09
SUD Up to the Minute - August 2022 (pdf)	2022 - 2023	2022-08-12
SUD Up to the Minute - July 2022 (pdf)	2022 - 2023	2022-07-20


FY21-22 Combined (pdf)		2022-09-08
FY20-21 Combined (pdf)		2022-01-07
FY19-20 Combined (pdf)		2022-01-07
FY18-19 Combined (pdf)		2022-01-07


Contingency Management Incentive Program (pdf)	Tip Sheet – Contingency Management Incentive Program 05/02/2023	2023-06-06
SanWITS_Users_Group_April_17,_2023.pdf	Presentation 04.17.23	2023-04-24
Tip Sheet 3-38 OOC Claim Details Report (pdf)	Tip Sheet	2023-04-12
Tip Sheet 3-37 OOC Claim Summary Report (pdf)	Tip Sheet	2023-04-12
SanWITS BHS County and Optum Staff User Form (pdf)	Revised 03/29/2023	2023-03-30
SanWITS Report Request Form (docx)	Revised 03/01/2023	2023-03-16
SanWITS User Modification Termination Form (pdf)	Revised 03/10/2023	2023-03-14
SanWITS New User Form (pdf)	Revised 03/10/2023	2023-03-14
Encounter Date Outside Program Enrollment Date Range (pdf)	Encounter Audit Findings 02/15/2023	2023-02-16
SanWITS Users Group Jan 23, 2023 (pdf)	Presentation 01/23/2023	2023-01-24
Memo - SanWITS DMC-ODS Data Entry Standards (pdf)	Revised 10/20/2022	2022-10-27
Tip Sheet NOABD Notice of Adverse Benefit Determination Notice (pdf)	Revised 10/20/2022	2022-10-27
SanWITS Users Group Oct 17, 2022 (pdf)	Presentation	2022-10-18
Tip Sheet - Early Intervention Service Program Enrollment (pdf)	Tip Sheet 09/22/2022	2022-09-22
Email –SanWITS Start and End Time No Longer Required (pdf)	Email 09/15/2022	2022-09-16
Email – SanWITS Notice – Delayed Admission Program Enrollment being Removed (pdf)	Email 09/15/2022	2022-09-16
SanWITS Users Group Jul 18, 2022 (pdf)	07/18/2022	2022-08-05
Tip Sheet: Courtesy Dosage Program Enrollment in SanWITS (pdf)	Revised 07/15/2022	2022-07-19
Tip Sheet - Before Admission After Discharge Program Enrollment (pdf)	Revised 06/22/2022	2022-06-22
SanWITS Users Group Jan 24, 2022 (pdf)		2022-05-12
SanWITS Users Group Apr 18, 2022 (pdf)		2022-05-12
Tip Sheet - New TUOS Detail Claim Report (pdf)	05/01/2022	2022-04-07
Tip Sheet - New TUOS Summary Report (pdf)	05/01/2022	2022-04-07
Tip Sheet – Recovery Residence Tracking (pdf)	Revised 1/27/2022	2022-01-28
SanWITS - Creating Diagnosis through Diagnostic Determination Notes DDN (pdf)	Revised 01/20/2022	2022-01-20
SanWITS - Telehealth and Telephone Service Encounter Tip Sheet (pdf)	Revised 12/16/2021	2021-12-16
SanWITS Users Group Oct 18, 2021 (pdf)	Presented: 10/18/2021	2021-10-27
Tip Sheet - Document Storage (pdf)	Revised 10/21/2021	2021-10-26
SanWITS Document Storage – Approved Documents for Attachment (pdf)	Revised 10/09/2021	2021-10-26
Special Notice regarding EHR Dual Entry (msg)	Email	2021-08-04
SanWITS Usesrs Group Jul 19 2021 (msg)	Email	2021-08-04
FW Important Notice - DATAR Capacity Reporting (msg)	Email	2021-08-04
Tip Sheet - Recovery Services (pdf)	Revised 07/19/2021	2021-07-22
Tip Sheet - Additional MAT - Split Dosing (pdf)	Tip Sheet - Revised 02/03/2021	2021-02-03
Tip Sheet - SanWITS EHR Readiness (pdf)	Revised 12/11/2020	2020-12-11
Basic Computer Skills Quiz (pdf)	Revised 12/11/2020	2020-12-11
Tip Sheet: Non-BHS Contracted Client Program Enrollment / CalOMS_Reporting (pdf)	Tip sheet	2020-10-28
SanWITS Billing Enhancements 20.4.5 (pdf)	Enhancements	2020-10-08
SanWITS Screen Enhancements 20.4.5 (pdf)	Enhancements	2020-10-08
Tip Sheet – OTP Reimbursement Rates Clarification (pdf)	Revised 9/23/20	2020-09-23
Tip Sheet - DSM 5 Diagnostic Labels in SanWITS (pdf)	Revised 9/21/20	2020-09-22
Tip Sheet – Drug Court Programs Workflow (pdf)	Revised 06/24/20	2020-06-25
SanWITS Flow Chart for Encounters Released to Bill and Placed on Hold (pdf)	Created 5/27/20	2020-06-15
SanWITS Flow – Group List for Outpatient Providers (pdf)	Revised 6/11/20	2020-06-12
DHCS Application Portal User Manual (pdf)		2020-04-21
DATAR Rewrite User Manual (pdf)		2020-04-21
Tip Sheet – Services provided via Telehealth (pdf)	Created 3/20/20	2020-03-25
Tip Sheet – Changing Level of Care (pdf)	Email	2020-03-06
Tip Sheet - Steps for Disallowed Services (pdf)	Created 08/23/2019	2020-02-06
Forms - CalOMS Profile S108A and S108B (pdf)		2019-12-12
Forms - CalOMS Annual Update S112 (pdf)		2019-12-12
Forms - CalOMS Admission S111 (pdf)		2019-12-12
Forms - CalOMS Discharge S703 (pdf)		2019-12-12
Forms - SanWITS Encounter S113 (pdf)		2019-12-12
Forms - SanWITS Intake S110 (pdf)		2019-12-12
Forms - SanWITS Contact S109 (pdf)		2019-12-12
CalOMS Tx Data Dictionary April 2018 (pdf)		2019-12-11
Tip Sheet - Residential Service Claims and Payor Group Enrollment (pdf)	Updated 05/30/2019	2019-08-05
Tip Sheet - Outpatient Service Claims and Payor Group Enrollment (pdf)	Updated 05/30/2019	2019-08-05
SanWITS SSRS Tip Sheet Run Reports (pdf)		2019-06-21
Service Claims and Payor Group Enrollment New Procedure (pdf)	MIS Informational Notice	2019-05-01
SanWITS Flow for Opioid Treatment Providers		2019-02-07
SanWITS Flow – Group List for Outpatient Providers (pdf)		2019-02-07
SanWITS Flow – Group List for OTP Providers (pdf)		2018-11-02
CalOMS Tx Data Collection Guide Jan 2014 (pdf)		2018-09-12


OTP Medicare PGE Tip Sheet (pdf)	Adding Benefit Plan Enrollment for OTP Medi-Medi clients	2021-03-03
Assignment of Insurance Benefits Form (pdf)	Revised 05-20-19	2019-07-22
BU Tip Sheet - Releasing Outpatient to OHC and Printing CMS 1500 Form (pdf)	Guides on how to process or release claims for clients with other health coverage and how to print the claim form via SanWITS.	2022-11-22
BU Tip Sheet - Releasing Residential Case Management to OHC and Printing CMS 1500 Form (pdf)		2020-08-05
Claim Item Hold Reasons (pdf)	to be utilized when putting claims in hold status	2020-10-02
DHCS 100186 Instructions (pdf)	How to complete the form	2020-09-25
DHCS 100186 or Claim Submission Certification Form (pdf)	Required billing certification form when submitting claim batch	2020-09-25
DHCS 6065A Form (pdf)	Late billing Good Cause Certification	2021-01-06
DHCS 6065A Form (xlsx)	Late billing Good Cause Certification	2021-01-06
DHCS 6065B Form (pdf)	Late billing and Good Cause Certification for DRC 8	2021-01-06
DHCS Drug Medi-Cal Billing Manual (pdf)	Updated April 2019	2019-04-29
DMC Organizational Providers Billing Manual (pdf)	Revised 04/20/2022	2022-04-25
Instructions on Completing 6065A Form		2021-01-06
Instructions on Completing 6065B Form		2021-01-06
MAT Dosing Same Day Billing Matrix (pdf)		2021-02-18
OTP Billing SanWITS Screens 11-21-2018 (pdf)		2018-12-06
OTP Disallowance After Release to Billing (pdf)	How to handle disallowances following the release to billing. Revised 12-15-2021	2021-12-16
OTP OOC Medi-Cal Tip Sheet (pdf)		2023-03-28
Outpatient Disallowance After Release to Billing (pdf)	This document is a revised version of the Disallowance After Release to Billing. It contains instructions on how to handle disallowances following the release to billing.	2021-12-16
Outpatient OOC Medi-Cal Tip Sheet (pdf)		2023-03-28
Outpatient Provider Billing SanWITS Screens (pdf)	Revised 06-14-2019	2019-06-21
PGE or Benefit Plan Review Billing Tip Sheet 11-19-2018 (pdf)		2018-12-06
Payment Recovery Form (Void-Disallowance) (xlsx)	Revised 09/2022 - Tab 2 contains the instructions.	2022-09-13
Residential Bed Day Billing SanWITS Screens (pdf)	Rev 05-01-2019	2019-06-10
Residential Bed Day Disallowance After Release to Billing (pdf)	How to handle disallowances following the release to billing. Revised 01/26/2022	2022-01-26
Residential Case Management Disallowance After Release to Billing (pdf)	How to handle disallowances following the release to billing. Revised 02-07-2022	2022-02-07
Residential Case Management-Recovery Services SanWITS Screens (pdf)	Rev 05-22-2019	2019-06-10
Residential OOC Medi-Cal Tip Sheet (pdf)		2023-03-28
SUD Aid Code Master Chart (xlsx)		2023-05-05
SUD Billing Announcement: Medicare Advantage Plan Rules for OTP Providers (msg)	Email announcement regarding Medicare Advantage billing rules	2022-07-14
SUD Billing Announcement: Other Health Coverage Rules for Outpatient Providers (msg)	Email announcement regarding OHC Rules	2022-07-14
SUD Billing Announcement: Other Health Coverage Rules for Residential Providers (msg)	Email announcement regarding OHC Rules	2022-07-14
SUD Billing Matrix (pdf)		2020-09-17
SUD DMC Billing Manual Summary of Changes (pdf)	Revised 10/20/2020	2020-10-26
SUD ICD-10 List (xls)		2019-11-25


PC 1000 Education Track Fee (pdf)		2019-08-29
PC 1000 Participant Handout (docx)	`	2019-08-29
PC 1000 Participant Status Report (pdf)	`	2019-08-29
PC 1000 Program Manual (pdf)	`	2019-08-29
PC 1000 Program Orientation Checklist (docx)	`	2019-08-29
PC 1000 Referral Form (pdf)	`	2019-08-29
PC 1000 SanWITS Education Track Flow (pdf)		2019-08-29
PC 1000 SanWITS Treatment Flow (pdf)		2019-08-29


One-Pager – Medical Director in DMC-ODS (pdf)		2021-12-28
10.29.20 SUD MD Exec Summary.pdf	Uploaded 11/12/2020	2020-11-12
10.15.20 SUD MD Exec Summary.pdf	Uploaded 11/12/2020	2020-11-12
10.01.20 SUD MD Exec Summary.pdf	Uploaded 11/12/2020	2020-11-12
9.17.20 SUD MD Exec Summary.pdf	Uploaded 10/01/2020	2020-10-01
8.06.20 SUD MD Exec Summary.pdf	Uploaded 10/01/2020	2020-10-01
8.20.20 SUD MD Exec Summary.pdf	Uploaded 10/01/2020	2020-10-01
5.28.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
4.09.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
5.14.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
4.23.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
4.03.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
7.23.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
6.25.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
7.09.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
4.16.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
6.11.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
4.30.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
5.07.20_SUD_MD_Exec_Summary.pdf	Uploaded 08/13/2020	2020-08-13
One-Pager – Medical Director Training Requirements (pdf)	Revised 4/21/20	2020-04-30
QM Memo - Physical Exam Requirements (pdf)		2019-10-03


00 – Archived List - Recovery Residences (pdf)	Revised 10/29/2020	2020-10-30
2020-04-20 - COVID Invoice Reporting Guidelines (pdf)		2020-09-01
One-Pager Recovery Residences – Supplemental Funding (COVID) (pdf)	Effective during COVID Health Emergency	2020-10-30
Recovery Residence Census Revised (xlsx)		2020-09-01


00 – Archived List – Monitoring (pdf)	Updated 10/06/2022	2022-10-12
Annual CME-CEU Requirement Tip Sheet	Updated 02/17/2022	2022-03-08
Corrective Action Steps for Disallowed Services (pdf)	10/09/2020	2020-10-30
FAQ for Client Contacts and Timely Access (pdf)		2021-09-22
Interim Services (pdf)	Updated 03/13/2023	2023-03-14
Interim Services (pdf)	Updated 07/16/2021	2021-08-18
MRR Tool FY22-23 (pdf)	Revised 10/05/2022	2022-10-11
MRR Tool FY22-23 - OTP (pdf)	Updated 07/20/2022	2022-10-05
Medication Monitoring Instructions (pdf)	06/20/2019	2019-09-09
Medication Monitoring McFloop Form (pdf)	06/19/2019	2019-09-09
Medication Monitoring Submission Fillable Form (pdf)	Revised 10/28/2020	2022-04-05
Medication Monitoring Tool (pdf)	Updated 07/29/2021	2021-08-05
PSPP Tip Sheet (pdf)	10/10/2022	2022-10-12
Provider Self Reporting Tool for Disallowances (xlsx)	Revised 10/13/2021	2021-10-26
Reasons for Disallowance (FY22-23) (pdf)		2022-08-12
Self-Identified Disallowances - Tip Sheet (pdf)	Updated 10/1/2020	2020-11-09


00 – Archived List – Peer Support (pdf)	Updated 6/28/2022	2022-06-30
2023-05-17-BHS Memo-Update on Peer Support Services Implementation (pdf)		2023-05-25
BHS HPA Peer Support Specialist Services Q and A (pdf)	Updated 06/01/2023	2023-06-01
Certified Peers (pdf)	Updated 03/2022	2022-05-16
Info Notice – BHS Peer Support Specialist Certification Program (pdf)	10/05/2021	2021-10-18
San Diego Certified Peer Support Specialist – TRAINING REQUIRMENTS (docx)		2023-05-25
San Diego Certified Peer Support Specialists – Billing Codes (docx)	FY2022-2023	2023-05-31
Scholarship Flyer – Peer Support Specialist Certification Program (pdf)		2022-10-19


Info_Notice_-_FY_17-18_Start-up_Cost_Amendment_-_Attachment_2.xlsx	2018 01/12 Issued	2018-06-06
Info_Notice_-_Start-up_Enhancements_for_FY_17-18_and_FY_17-18_-_Attachment_1.xlsx	2018 01/31 Issued	2018-06-06
Info_Notice_-_FY_17-18_Start-up_Cost_Amendment_-_Attachment_1.xlsx	2018 01/12 Issued	2018-06-06
Info_Notice_-_FY_17-18_Start-up_Cost_Amendment.pdf	2018 01/12 Issued	2018-06-06
Info_Notice_-_Start-up_Enhancements_for_FY_17-18_and_FY_17-18.pdf	2018 01/31 Issued	2018-06-06
Info_Notice_-_FY_17-18_DMC-ODS_Enhancement_Budget-Invoice_Process.pdf	2018 04/05 Issued	2018-06-06
Info_Notice_-_FY_17-18_DMC-ODS_Enhancement_Budget-Invoice_Process_-_Attachment_2.xlsx	2018 04/05 Issued	2018-06-06
DMC Budget Master Template FINAL.xlsm		2021-09-02
FY2122 Provider Rate Cap (pdf)		2021-09-02
Info Notice - DMC-ODS Twice-a-Month Invoice Process (pdf)	2018 07/02 Issued	2018-07-09
Info Notice - DMC-ODS – Total Units of Service (TUOS) Report Distribution (pdf)	2019 08/13 Issued	2019-08-14
Info Notice - FY 17-18 DMC-ODS Enhancement Budget-Invoice Process - Attachment 1 (pdf)	2018 05/17 Issued	2018-06-06
Info Notice - Rate Cap Waiver Extension (Q3) (pdf)	2018 12/18 Emailed	2018-12-20
Info Notice - Rate Cap Waiver Extension (pdf)	2018 09/19 Emailed	2018-10-02
Info Notice - Rate Cap Waiver for First Quarter (Q1) (pdf)	2018 08/07 Issued	2018-08-09
Info Notice - Unit Production Plan (Q4) (pdf)	2019 04/04 Emailed	2019-04-10
Info Notice - Unit Production Plan (pdf)	June 17, 2019	2019-07-24
Info Notice – Extension of DMC Billable Unit Production Plan.pdf	Dec 19, 2019	2019-12-23
Info_Notice_-_FY_17-18_DMC-ODS_Enhancement_Budget-Invoice_Process_-_Attachment_3.xlsx	2018 04/05 Issued	2018-06-06
Invoicing – DMC-ODS Residential Providers (pdf)	June 27, 2019	2019-06-28
New TUOS Tip Sheet for Invoicing – OTP (pdf)	02/22/2022	2022-04-08
New TUOS Tip Sheet for Invoicing – RES and Outpatient (pdf)	02/22/2022	2022-04-08