Medi-Cal Certification

Forms & Training for Medi-Cal Certifications	Revision Date
Medi-Cal Application - County Programs	09/2014
Medi-Cal Application - Contracted Programs	01/24/2022
Medi-Cal Certifications & Re-Certification Training (PowerPoint)	11/13/2017

Medi-Cal Certification & Recertification Protocol
County	09/07/2022
Contractor	09/07/2022
CSU	11/22/2022

Medi-Cal Binder Table of Contents - County
County with Medication Room	04/12/2023
County without Medication Room	04/12/2023
County CSU with Medication Room	04/12/2023

Medi-Cal Binder Table of Contents - Contractors
Contractors with Medication Room	04/12/2023
Contractors without Medication Room	04/12/2023
Contractor CSU with Medication Room	04/12/2023

Supporting Documents
Pertinent Information Form	07/06/2022
Physical Plant Inspection Checklist	05/06/2022
Sanction Screening Sample (Contractors Only)	09/23/2021
Signature Log Template	07/06/2022
Staff Schedule Templates	04/12/2023

Medication Room Forms	Revision Date
Medication Refrigerator & Room Temperature Record (F346-709)	12/2021
Record of Medication Receipts, Storage, Administration and Disposal Non-Controlled (F346-709)	12/2021
Record of Medication Receipts, Storage, Administration and Disposal Controlled (F346-709C)	05/2022
Daily Record of Medication Storage (Controlled)	12/2021
OC BHS Medication Room Annual Review Checklist	02/2022

COVID-19 Updates