Clinical Information
Pediatric Symptom Checklist (County Version) |

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Pediatric Symptom Checklist (Contract Version) |

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PSC-35 IRIS Entry Quick Guide (Contracts) |
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PSC 35 Interpretation |
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Clinical Supervision
Change of Provider/Second Opinion Log - NEW
Continuity of Care
Medication Consents [F346-7921] - 2019
Psychiatrist Information/Downloads
Medi-Cal Information
HIPAA - Notice of Privacy Practices
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
Click on the icons in the tables below to download the appropriate file.
Advance Health Care Directives (F346-705)
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Mental Health Plan Intake/ Advisement Checklist
(F346-753) (October 2017)
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Grievance or Appeal Form
(F346-706) (October 2017)
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Grievance & Appeal Process Posters
(October 2017)
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updated 1/27/22 |

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updated 1/27/22 |

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Grievance Tracking Form |
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Grievance Fact Sheet
(July 2020)
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Medi-Cal Handbook
(2019)
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Audio Version
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Forms - FOR COUNTY OPERATED PROVIDER USE ONLY
Car Seat Safety Flyers (County Use Only)
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)
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)