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Medi-Cal Informing Materials

Medi-Cal logo 174These 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: 46 Kb )

Request for Change of Service Provider
English| Spanish (PDF: 46 Kb )

Client Rights Flyer

Client Rights Flyer
English| Spanish (PDF: 141 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: 46 Kb )
(Print on 8.5" x 14" white paper)

Consumer Notification of Licensing Boards

Consumer Notification of Licensing Boards
English/Spanish (PDF: 67 Kb )
(Print on 8.5" x 11" paper)

Early and Periodic Screening Form

Early & Periodic Screening & Diagnosis Including Therapeutic Behavioral Services
English| Spanish (PDF: 65 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: 95 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)

Provider Directory for Specialty Mental Health Services

Provider Directory for Specialty Mental Health Services
English| Spanish (PDF: 72 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: 316 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: 55.4 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

3322 Chanate Rd.

Santa Rosa, CA 95403

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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