County of Marin Health and Human Services

02 Appendices- BHRS Mental Health Contractor Manual

A collection of documents available to Marin County mental health contract agency partners.

AttachmentSize
PDF icon BHRS Reauthorization Request Form61.63 KB
PDF icon BHRS Standards for Clinical Records17.51 KB
PDF icon CMS 1500 Blank Form3.03 MB
PDF icon CMS 1500 Sample Form1.95 MB
PDF icon DHCS Medi-Cal Site Certification Recertification Protocol833.56 KB
PDF icon HHS Confidentiality and Privacy 308.49 KB
PDF icon Discharge Form382.94 KB
PDF icon Notice of Privacy Practices Acknowledgement104.61 KB
PDF icon Notice of Privacy Practices 63.44 KB
PDF icon Utilization/Review Guidelines for Fee for Service Providers116.88 KB
PDF icon Grievance Brochure (English)178.46 KB
PDF icon Grievance Brochure (English) - Large Font227.86 KB
PDF icon Grievance Brochure (Español)246.92 KB
PDF icon Grievance Brochure (Español) – Large Font245.43 KB
PDF icon Grievance Brochure (Vietnamese)448.58 KB
PDF icon Grievance Brochure (Vietnamese) - Large Font395.28 KB
PDF icon Greivance Appeal Poster (English)256.2 KB
PDF icon Grievance Appeal Poster (Spanish)81.16 KB
PDF icon Grievance Appeal Poster (Vietnamese)160.93 KB
PDF icon Change of Provider Request Form (English)169.64 KB
PDF icon Change of Provider Request Form (English) - Large Font171.19 KB
PDF icon Change of Provider Request Form (Spanish)103.8 KB
PDF icon Change of Provider Request Form (Spanish) - Large Font105.63 KB
PDF icon Change of Provider Request Form (Vietnamese)121.13 KB
PDF icon Change of Provider Request Form (Vietnamese) - Large Font138.19 KB
File Cultural Competence Tracking for Contracted Agencies32.08 KB
PDF icon Beneficiary Handbook (English)1.08 MB
PDF icon Beneficiary Handbook (English) - Large Font1.23 MB
PDF icon Beneficiary Handbook (Español)585.06 KB
PDF icon Beneficiary Handbook (Español) - Large Font714.75 KB
PDF icon Beneficiary Handbook (Vietnamese)1.19 MB
PDF icon Beneficiary Handbook (Vietnamese) - Large Font1.27 MB
PDF icon Advance Health Care Directive Form – English75.77 KB
PDF icon Advance Health Care Directive Form – Spanish75.82 KB
PDF icon Advance Directives Handout – English181.39 KB
PDF icon Advance Directives Handout – Spanish293.73 KB
PDF icon Language Assistance Taglines Handout – 12 pt.682.64 KB
PDF icon Language Assistance Taglines Poster – 18 pt.685 KB
PDF icon Continuity of Care Brochure (English)196.04 KB
PDF icon Continuity of Care Brochure (Spanish)192.28 KB
PDF icon Continuity of Care Brochure (Vietnamese)236.65 KB