AQIS - AOABH MHRS Downloads

All consumer posters and brochures for Medi-Cal clinic sites are downloadable from this page. Please contact AQIS AOABH at ksabet@ochca.com or call (714) 834-5601 for any questions. Patient's rights posters and brochures are in downloadable format at the Patients' Rights Advocacy Services website. Visit the Office of Compliance website or call (714) 568-5614 to ask questions or report a concern.

Clinical Information

• BH Provider Handbook Coding Manual Version 11(Effective November 2020)
• Clinician Coding Guide (Non-MD) (Effective 4/4/18)
• Clinician Coding Guide (MD) (Effective 4/4/18)
• Revised Encounter Document FAQ (1-7-14)
• Legal Classes and Court Conservator Status
• Service Strategies
• CANS & PSC-35 FAQ(6/25/2020)
• CA CANS 50 ADA with County Logo 9-15-18
• CA CANS 50 ADA without County Logo 9-26-18
• CANS IRIS Entry Quick Guide (Contracts) 

 

Title	Arabic	Chinese	English	Farsi	Korean	Spanish	Vietnamese
Pediatric Symptom Checklist (County Version)
Pediatric Symptom Checklist (Contract Version)
PSC-35 IRIS Entry Quick Guide (Contracts)
PSC 35 Interpretation

 

Clinical Supervision

• Clinical Supervision Reporting Form 2022.01.14
• MHRS-AQIS A Guide to Clinical Supervision 2020.08.12

Change of Provider/Second Opinion Log - NEW 

• AOABH Change of Provider/Second Opinion Log - County Clinic Form
• AOABH Change of Provider/Second Opinion Log - Contract Clinic Form

Continuity of Care  

• Continuity of Care P&P 09.01.08
• AQIS Continuity of Care Request Form
• Continuity of Care - Training

Medication Consents  [F346-7921] - 2019

• Arabic
• Chinese
• English
• Farsi
• Korean
• Spanish
• Vietnamese

Psychiatrist Information/Downloads

• MHRS Formulary
• Treatment Authorization Request (TAR)

Medi-Cal Information

• MHRS Medi-Cal Provider Information Page
• Medi-Cal Mental Health Plan - Provider Directory
• Provider Directory - Quick Guide [For Providers]
• Provider Directory - Translation Features

    HIPAA - Notice of Privacy Practices

• Link to Notice of Privacy Practices  (County Operated Provider Use Only) 

Authorization to Use or Disclose Protected Health Information (PHI) 

Please Clink links below to access the most up-to-date Authorization to Use or Disclose (ATD) PHI forms

• For Patient/Client use for Medical Records Request from Custodian of Records
• Revocation of Authorization to Use or Disclose Public Health Information 
• For Clinic Use - County Intranet

 

Click on the icons in the tables below to download the appropriate file.

 

Description	Arabic		Chinese	English		Farsi		Korean		Spanish		Vietnamese
Advance Health Care Directives (F346-705)
Mental Health Plan Intake/ Advisement Checklist (F346-753) (October 2017)
Grievance or Appeal Form (F346-706) (October 2017)
Grievance & Appeal Process Posters (October 2017)				updated 1/27/22						updated 1/27/22
Grievance Tracking Form
Grievance Fact Sheet (July 2020)
Medi-Cal Handbook (2019)
Audio Version

 

Forms - FOR COUNTY OPERATED PROVIDER USE ONLY

Car Seat Safety Flyers (County Use Only)   

 

Description	Chinese	English	Korean	Spanish	Vietnamese
National Voter Registration Act (NVRA) Preference Forms National Voter Registration FAQs (County Operated Provider Use Only)

Notice of Privacy Practices (NPP)

This is the County NPP given to patients/clients at the first delivery of medical treatment services. The NPP is also mailed to patients/clients provided medical benefits under an HCA supported health plan such as CCS, MSN, or CTU. Form #F042-01.1996 (County Operated Provider Use Only) 

•  Arabic
•  Chinese New
•  English
•  Farsi
•  Korean
•  Spanish
•  Vietnamese

Notice of Privacy Practices Acknowledgement

This form helps the Orange County Health Care agency demonstrate that we have given our Notice of Privacy Practices (NPP) to each patient at the first point of service. This form is used to obtain client/patients signed acknowledgement of receipt. (County Operated Provider Use Only) 

• Arabic
• Chinese New
• English
• Farsi
• Korean
• Spanish
• Vietnamese

   

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