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)