On this page you will find contractor resources available in PDF, DOC, and XLS format.
00 General Information
A collection of documents available to Marin County mental health contract agency partners.
01 Resources - BHRS Mental Health Contractor Manual
A collection of documents available to Marin County mental health contract agency partners.
02 Appendices- BHRS Mental Health Contractor Manual
A collection of documents available to Marin County mental health contract agency partners.
BHRS Reauthorization Request Form- BHRS Standards for Clinical Records
- BHRS Clinical Documentation Guide
- CMS 1500 Blank Form
- CMS 1500 Sample Form
- DHCS Medi-Cal Site Certification Recertification Protocol
- HHS Confidentiality and Privacy
- Notice of Privacy Practices Acknowledgement
- Notice of Privacy Practices
- Grievance Brochure (English)
- Grievance Brochure (English) - Large Font
- Grievance Brochure (Español)
- Grievance Brochure (Español) – Large Font
- Grievance Brochure (Vietnamese)
- Grievance Brochure (Vietnamese) - Large Font
- Grievance Appeal Poster (English)
- Grievance Appeal Poster (Spanish)
- Grievance Appeal Poster (Vietnamese)
Cultural Competence Tracking for Contracted Agencies- Beneficiary Handbook (English)
- Beneficiary Handbook (English) - Large Font
- Beneficiary Handbook (Español)
- Beneficiary Handbook (Español) - Large Font
- Beneficiary Handbook (Vietnamese)
- Beneficiary Handbook (Vietnamese) - Large Font
- Advance Health Care Directive Form – English
- Advance Health Care Directive Form – Spanish
- Advance Directives Handout – English
- Advance Directives Handout – Spanish
- Language Assistance Taglines Handout – 12 pt.
- Language Assistance Taglines Poster – 18 pt.
- Continuity of Care Brochure (English)
- Continuity of Care Brochure (Spanish)
- Continuity of Care Brochure (Vietnamese)
- Diagnosis Dx Update Form
- Discharge Form
- change of provider request form -english
- change of provider request form 18 font english
- change of provider form - spanish
- change of provider form 18 font spanish
- change of provider form vietnamese
- change of provider form 18 font vietnamese
- Client Profile Form - English
- Perfil del Cliente (Client Profile Form - Spanish)
03 Notice of Adverse Benefit Determination (NOABD)
- NOABD Policy Notice of Adverse Benefit Determination (English)
- NOABD Table (which NOABD to use)
NOABD training powerpoint- NOABD Your Rights Attachment (English)
- NOABD Your Rights Attachment (Spanish)
- NOABD Beneficiary Nondiscrimination Notice (English)
- NOABD Beneficiary Nondiscrimination Notice (Spanish)
- Language Assistance
NOABD authorization delay (english)- NOABD authorization delay (spanish)
- NOABD delivery system (english)
- NOABD delivery system (spanish)
- NOABD denial (english)
- NOABD denial (spanish)
- NOABD financial liability notice (english)
- NOABD financial liability notice (spanish)
- NOABD modification notice (english)
- NOABD modification notice (spanish)
- NOABD payment denial (english)
- NOABD payment denial (spanish)
- NOABD termination notice (english)
- NOABD termination notice (spanish)
- NOABD timely access (english)
- NOABD timely access (spanish)