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Medi-Cal Informing Materials

Medi-Cal logo

These documents are given to clients receiving specialty mental health services that are covered by Medi-Cal.

Featured Materials

Client Rights & Grievance/Appeal Process and Form
English| Spanish (PDF: 826 and 625 kB)

Request for Change of Service Provider
English| Spanish (PDF: 766 and 374 kB )

Beneficiary Handbook Cover thumbnail 35

Beneficiary Handbook   
English| Spanish (PDF: 1.64 and 1.27 MB)
Large type: English| Spanish (PDF: 1.63 and 2.01 MB)
(Print on 8.5" x 14" white paper)

Client Rights Flyer

Client Rights Flyer
English| Spanish (PDF: 102 and 27 kB)
(Print on 8.5" x 14" paper)

Clients Rights and Grievance appeal Process Form

Client Rights & Grievance/Appeal Process and Form
English| Spanish (PDF: 826 and 625 kB)
Large type: English| Spanish (PDF: 785 and 591 kB)
(Print on 8.5" x 14" white paper)

Consumer Notification of Licensing Boards

Consumer Notification of Licensing Boards
English/Spanish (PDF: 80 kB)
(Print on 8.5" x 11" paper)

Early and Periodic Screening Form

Early & Periodic Screening & Diagnosis Including Therapeutic Behavioral Services
English| Spanish (PDF: 670 and 608 kB)
(Print on 8.5" x 11" white paper)

Family Feedback Flyer

Family Feedback Flyer
English| Spanish (PDF: 126 kB)
(Print on 8.5" x 11" paper)

Adult Family Feedback Form

Family Feedback Form - Adult Services
English| Spanish (PDF: 126 kB)
(Print on 8.5" x 11" buff paper)

Children Family Feedback Form

Family Feedback Form- Children's Services
English| Spanish (PDF: 142 kB)
(Print on 8.5" x 11" green paper)

Free Language Assistance flyer

Free Language Assistance Services
English/Spanish (PDF: 48 kB)
(Print on 8.5" x 11" paper)

Guide to Medi-Cal Mental Health Services

Guide to Medi-Cal Mental Health Services
English| Spanish (PDF: 3.3 Mb)
Large type: English| Spanish (PDF: 3.1 MB)
(Print on 8.5" x 11" white paper)

CTS Point to Your Language thumbnail 35

Point to Your Language Poster
English/Spanish(PDF: 116 kB)
(Print on 11" x 17" paper)

Provider Directory for Specialty Mental Health Services

Provider Directory for Specialty Mental Health Services
English| Spanish (PDF: 226 & 225 kB)
Large type: English| Spanish (PDF: 828 & 946 kB)
(Print on 8.5" x 11" white paper)

Your Right to Make Decisions About Medical Treatment

Your Right to Make Decisions About Medical Treatment
English| Spanish (PDF: 459 and 573 kB)
(Print on 14" x 8.5" tan paper)

Privacy Practices

Attention contractors: You are required by law to provide clients with your own HIPAA Notice of Privacy Practices statement.

Attention clients: these are the County Mental Health Services Notice of Privacy Practices statements.

Notice of Privacy Practices for Health Care Clients
Print version: English | Spanish (PDF: 61 and 71 kB)

Form: Acknowledgement of Receipt of Notice of Privacy Practices
English | Spanish (PDF: 34.8 kB)

Contact Information

Behavioral Health Division

Health Services

Contact us by Phone
Address

2227 Capricorn Way

Suite 207

Santa Rosa, CA 95407

Mental Health Hotlines

24-hour Access Line

(707) 565-6900
(800) 870-8786

24-Hour Crisis Services

(707) 576-8181
Crisis Stabilization Unit
2225 Challenger Way, Santa Rosa

24-hour Suicide Prevention

(855) 587-6373

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