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County of Sonoma California

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Medi-Cal Informing Materials, Grievance, Change of Provider Materials

These documents are given to clients receiving specialty mental health services that are covered by Medi-Cal.

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Client Rights Flyer
(Print on 8.5" x 14" paper)
   English (pdf)
   Spanish (pdf)

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Client Rights & Grievance/Appeal Process and Form
(Print on 8.5" x 14" white paper)
   English (pdf)
   Spanish (pdf)

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Consumer Notification of Licensing Boards
(Print on 8.5" x 11" paper)
   English/Spanish (pdf)

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Early & Periodic Screening & Diagnosis Including Therapeutic Behavioral Services
(Print on 8.5" x 11" white paper)
   English (pdf)
   Spanish (pdf)

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Family Feedback Form
(Print on 8.5" x 11" paper)
   English (pdf)
   Spanish (pdf)

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Family Feedback Form - Adult Services
(Print on 8.5" x 11" buff paper)
   English (pdf)
   Spanish (pdf)

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Family Feedback Form- Children's Services
(Print on 8.5" x 11" green paper)
   English (pdf)
   Spanish (pdf)

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Free Language Assistance Services
(Print on 8.5" x 11" paper)
   English/Spanish (pdf)

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Guide to Medi-Cal Mental Health Services
(Print on 8.5" x 11" white paper)
   English (pdf)
   English - Large Type (pdf)
   Spanish (pdf)
   Spanish - Large Type (pdf)

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Provider Directory for Specialty Mental Health Services
(Print on 8.5" x 11" white paper)
   English (pdf)
   Spanish (pdf)

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Your Right to Make Decisions About Medical Treatment
(Print on 14" x 8.5" tan paper)
   English (pdf)
   Spanish (pdf)

Privacy Practices

Attention contractors: You are required by law to provide clients with your own HIPPA Notice of Privacy Practices statement.

Attention clients: these are the County Mental Health Services Notice of Privacy Practices statements.

Notice of Privacy Practices for Health Care Clients
English | Spanish (pdf)

Notice of Privacy Practices for Health Care Clients Acknowledgement
English | Spanish (pdf)

Client Rights & Grievance/Appeal Process and Form

(Print on 8.5" x 14" blue paper)
English (pdf)
Spanish (pdf)

Request for Change of Service Provider

English (pdf)

Spanish (pdf)

Contact

For questions about these documents, please call:

(707) 565-4850

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