All consumer posters and brochures for Medi-Cal clinic sites are downloadable from this page.
Please contact AQIS CYPBH at AQISSupportTeams@ochca.com or call (714) 796-0123 for any questions.
Patient's rights posters and brochures are in downloadable format at the
Patients' Rights Advocacy Services website.
Please contact Patients Rights Advocacy Services at (714) 834-5647 for any additional questions.
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Clinical Information
Caregiver Intake Questionnaires
8/7/19
Clinical Resources
Clinical Supervision
Change of Provider/Second Opinion Log - NEW
Medication Consents [F346-7921] - 2019
Outcome Measure Workflows
01/13/2020
Pediatric Symptom Checklist
Psychiatrist Information/Downloads
Continuity of Care
Medi-Cal Information
Advance Health Care Directives (F346-705)
Authorization to Use or Disclose Protected Health Information (PHI)
Please click links below to access the most up-to-date Authorization to Use or Disclose (ATD) PHI forms
EPSDT-TBS Brochures (MC-003-DHCS)
Grievance or Appeal Form (F346-706) (October 2017)
Grievance Tracking Form
Grievance or Appeal Process Posters (October 2017)
HIPAA - Notice of Privacy Practices
Medi-Cal Handbook
Mental Health Plan Intake/Advisement Checklist (F346-753) (October 2017)
Forms - FOR COUNTY OPERATED PROVIDER USE ONLY