Medi-Cal Informing Materials
Featured Materials
Client Rights & Grievance/Appeal Process and Form
English |
Spanish (PDF: 786 and 789 kB)
Request for Change of Service Provider
English |
Spanish (PDF: 766 and 374 kB)
MHS 112-1 NOABD Service Denial Notice
English |
Spanish(PDF: 856 and 879 kB)
MHS 112-3 NOABD Delivery System Notice
English (PDF: 859 kB)
MHS 112-4 NOABD Modification Notice
English (PDF: 886 kB)
MHS 112-5 NOABD Termination Notice
English |
Spanish(PDF: 838 and 882 kB)
MHS 112-6 NOABD Authorization Delay Notice
English |
Spanish(PDF: 833 and 868 kB)
MHS 112-7 NOABD Timely Access Notice
English |
Spanish(PDF: 825 and 860 kB)
MHS 112-8 NOABD Financial Liability Notice
English (PDF: 834 kB)
MHS 168 Beneficiary Request for Service Authorization
English (PDF: 260 kB)
These documents are given to clients receiving specialty mental health services that are covered by Medi-Cal.
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Beneficiary Handbook UPDATE AVAILABLE MARCH 10TH, 2023 |
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Client Rights Flyer |
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Client Rights & Grievance/Appeal Process and Form |
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Consumer Notification of Licensing Boards |
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Early & Periodic Screening & Diagnosis Including Therapeutic Behavioral Services |
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Family Feedback Flyer |
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Family Feedback Form - Adult Services |
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Family Feedback Form- Children's Services |
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Free Language Assistance Services |
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Point to Your Language Poster |
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Provider Directory for Specialty Mental Health Services - June 2023 (Updated Monthly) |
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Provider Directory for Substance Use Treatment Services - April 2023 (Updated Monthly) |
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Your Right to Make Decisions About Medical Treatment |
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Beneficiary Non-Discrimination Notice |
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: 193 and 122 kB)
Form: Acknowledgement of Receipt of Notice of Privacy Practices
English |
Spanish (PDF: 34.8 kB)