A collection of documents available to Marin County mental health contract agency partners. AttachmentSize BHRS Reauthorization Request Form61.63 KB BHRS Standards for Clinical Records17.51 KB BHRS Clinical Documentation Guide2.64 MB CMS 1500 Blank Form3.03 MB CMS 1500 Sample Form1.95 MB DHCS Medi-Cal Site Certification Recertification Protocol833.56 KB HHS Confidentiality and Privacy 308.49 KB Notice of Privacy Practices Acknowledgement104.61 KB Notice of Privacy Practices 63.44 KB Grievance Brochure (English)178.46 KB Grievance Brochure (English) - Large Font227.86 KB Grievance Brochure (Español)246.92 KB Grievance Brochure (Español) – Large Font245.43 KB Grievance Brochure (Vietnamese)448.58 KB Grievance Brochure (Vietnamese) - Large Font395.28 KB Grievance Appeal Poster (English)256.2 KB Grievance Appeal Poster (Spanish)81.16 KB Grievance Appeal Poster (Vietnamese)160.93 KB Cultural Competence Tracking for Contracted Agencies32.08 KB Beneficiary Handbook (English)1.08 MB Beneficiary Handbook (English) - Large Font1.23 MB Beneficiary Handbook (Español)585.06 KB Beneficiary Handbook (Español) - Large Font714.75 KB Beneficiary Handbook (Vietnamese)1.19 MB Beneficiary Handbook (Vietnamese) - Large Font1.27 MB Advance Health Care Directive Form – English75.77 KB Advance Health Care Directive Form – Spanish75.82 KB Advance Directives Handout – English181.39 KB Advance Directives Handout – Spanish293.73 KB Language Assistance Taglines Handout – 12 pt.682.64 KB Language Assistance Taglines Poster – 18 pt.685 KB Continuity of Care Brochure (English)196.04 KB Continuity of Care Brochure (Spanish)192.28 KB Continuity of Care Brochure (Vietnamese)236.65 KB Diagnosis Dx Update Form330.83 KB Discharge Form283.16 KB change of provider request form -english191.29 KB change of provider request form 18 font english190.01 KB change of provider form - spanish126.52 KB change of provider form 18 font spanish125.04 KB change of provider form vietnamese142.69 KB change of provider form 18 font vietnamese157.13 KB Client Profile Form - English343.32 KB Perfil del Cliente (Client Profile Form - Spanish)419.52 KB Related Pages: Mental Health Services Contractor Resources
