All consumer posters and brochures for Medi-Cal clinic sites are downloadable at the following page - click here. Please contact QMS AOA at AQISSupportTeams@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)
• Integrated Practice CANS Form in English (4/1/2022)
• CANS IRIS Entry Quick Guide (Contracts)
• CANS Training Website Sign-Up Guide (01/31/2024)
• CANS Recertification Guide (01/31/2024)

 

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

Click here for up-to-date information on Clinical Supervision Reporting Forms

Change of Provider/Second Opinion Log

Click here for up-to-date information on Change of Provider and Second Opinion Logs

Continuity of Care

Forms

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

Policy and Procedure

• Continuity of Care P&P 09.01.08

Training

• Continuity of Care - Training

Medication Consents  [F346-7921] - 2019

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

Psychiatrist Information/Downloads

• BHS Formulary
• Treatment Authorization Request (TAR)

Medi-Cal Information

• BHS 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)
Medi-Cal Handbook (2019)
Audio Version

Grievance Forms, Posters, Fact Sheets and Tracking Forms

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

Read about downloading files.