BHS Downloads and Client Informing Materials

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

Title

Arabic

English

Farsi

Korean

Spanish

Vietnamese

Pediatric Symptom Checklist (County Version)

 

Pediatric Symptom Checklist (Contract Version)

PSC-35 IRIS Entry Quick Guide (Contract Programs)

PSC 35 Interpretation

     Clinical Supervision

Continuity of Care  

Medication Consents  [F346-7921] - 2019

Psychiatrist Information/Downloads

Medi-Cal Information (For Distribution to Consumers)

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.

Description

Arabic

English Farsi

Korean

Spanish

Vietnamese

Advance Health Care Directives (F346-705)

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

Spanish PDF version of Notice of Privacy Practices Employee Benefits

Vietnamese PDF version of Notice of Privacy Practices Employee Benefits

Mental Health Plan Intake/ Advisement Checklist
(
F346-753) (October 2017)

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

Grievance or Appeal Form
(F346-706) (October 2017)

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

Grievance & Appeal Process Posters
(October 2017)

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

Grievance Fact Sheet
(July 2020)

PDF version of Notice of Privacy Practices Employee Benefits

Medi-Cal Handbook
(October 2017)

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

Audio Version

Involuntary Detention Information 

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) 


PDF version of Notice of Privacy Practices Employee Benefits
 

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits
 

Spanish PDF version of Notice of Privacy Practices Employee Benefits

Vietnamese PDF version of Notice of Privacy Practices Employee Benefits

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) 

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)