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Mental Health Plan and Provider Information

 

Medi-Cal Mental Health Plan - Provider Directory

Document

MC MHP Handbook and Provider Directory Lobby Notice

Consumer Handbook - Guide to Medi-Cal Mental Health Services

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This guide will help you know what specialty mental health services are, if you may get them, and how you can get help from the Orange County MHP.

For general information and accessibility issues please call:

Orange County Mental Health Plan

Phone: 800-723-8641
For TTY/TDD users, call 711

 

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This guide is also available (MP3 audio format) in multiple languages.
About listening to files

Sections Arabic English Farsi Korean Spanish Vietnamese
1. Medi-Cal Handbook County Section Part 1 (mp3) Part 1 (mp3)

Part 1 (mp3)

Part 1 (mp3) Part 1 (mp3) Part 1 (mp3)
2. Medi-Cal Handbook State Section Part 2 (mp3) Part 2 (mp3)

Part 2 (mp3)

Part 2 (mp3) Part 2 (mp3) Part 2 (mp3)

 

 

BH Provider Handbook Coding Manual 

Behavioral Health Provider Handbook Coding Manual Version 11 (November 2020)
(121 page pdf file)

 

Forms / Brochures

 

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Arabic

Chinese

English

Farsi

Korean

Spanish

Vietnamese

Advance Health Care Directives (F346-705)

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Grievance or Appeal Form (F346-706)

Grievance or Appeal Form (Arabic)

Grievance or Appeal Form (Chinese)

Grievance or Appeal Form (English)

Grievance or Appeal Form (Farsi)

Grievance or Appeal Form (Korean)

Grievance or Appeal Form (Spanish)

Grievance or Appeal Form (Vietnamese)

Grievance & Appeal Process Posters *** UPDATED ***

Grievance and Appeal Process Posters (Arabic)

Grievance and Appeal Process Posters (Chinese)

Grievance and Appeal Process Posters (English)

Grievance and Appeal Process Posters (Farsi)

Grievance and Appeal Process Posters (Korean)

Grievance and Appeal Process Posters (Spanish)

Grievance and Appeal Process Posters (Vietnamese)

Grievance Fact Sheet MHP    

Grievance and Appeal Process Posters (English)

   

Grievance and Appeal Process Posters (Spanish)

Grievance and Appeal Process Posters (Vietnamese)

Authorization to Use and Disclose Protected Health Information (F346-531B)

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Consent to Record (F346-474)

 

 

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Mental Health Plan Intake/Advisement Checklist (F346-753)

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Psychiatric Medication Consent (F346-7921)

Psychotropic Medication Consent (English)

Psychotropic Medication Consent (Chinese)

Psychotropic Medication Consent (English)

Psychotropic Medication Consent (English)

Psychotropic Medication Consent (English)

Psychotropic Medication Consent (Spanish)

Psychotropic Medication Consent (English)

Informed Consent for Services - General (F346-301)

Informed Consent

 

Informed Consent

Informed Consent

Informed Consent

Informed Consent

Informed Consent

Informed Consent for Telehealth and Telephonic Services

Informed Consent - Telehealth

Informed Consent - Telehealth 
Informed Consent - Telehealth

Informed Consent - Telehealth

Informed Consent - Telehealth

Informed Consent - Telehealth

Informed Consent - Telehealth

Informed Consent - Telehealth

Telehealth Email Acknowledgement Form

Telehealth Email Acknowledgement

Telehealth Email Acknowledgement

Telehealth Email Acknowledgement

 

Telehealth Email Acknowledgement

Telehealth Email Acknowledgement

Telehealth Email Acknowledgement

AQIS Continuity of Care Request Form    

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National Voter Registration Act (NVRA) Preference Forms (County Operated Provider Use Only)
National Voter Registration FAQs

 

NVRA Forms

NVRA Forms

 

NVRA Forms

NVRA Forms

NVRA Forms

Clinical Supervision Reporting Form

 

 

NVRA Forms

 

 

 

 

NOABD

 
Notice of Adverse Benefit Determination-Delivery System

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Notice of Adverse Benefit Determination- Modification Notice

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Notice of Adverse Benefit Determination- Termination Notice

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NOABD Beneficiary Non--Discrimination Notice

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Notice of Adverse Benefit Determination- Your Rights Notice

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Language tagline

 

 

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NOABD-Delivery System, Modifications and Termination, Reminders 12/2018

 

 

 

 

 

 

Car Seat Safety Flyers (County Operated Provider Use Only) 
Notice of Privacy Practices (NPP) (County Operated Provider Use Only) 
Patients' Rights Downloads

For information and resources about the Drug Medi-Cal Organized Delivery System (DMC-ODS), visit http://www.ochealthinfo.com/DMC-ODS