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AQIS - AOABH BHS 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

 

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

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.

 

Description

Arabic

Chinese 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

Medi-Cal Handbook
(2019)

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

 

 

 

 

 

 

 

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) 


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) 

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