You are here:

Medi-Cal Informing Materials

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

Thumbnail image of document

Consumer Rights and Grievance Process
(Print on 8.5" x 11" blue paper)
   English (pdf)
   Spanish (pdf)

Thumbnail image of document

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

Thumbnail image of document

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

Thumbnail image of document

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

Thumbnail image of document

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

Thumbnail image of document

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

Thumbnail image of document

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

Thumbnail image of document

Therapeutic Behavioral Services
(Print on 8.5" x 11" green paper)
   English (pdf)
   Spanish (pdf)

Thumbnail image of document

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

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

Read County Notice of Privacy Practices statements

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

Notice of Privacy Practices for Health Care Clients (pdf)

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

Notice of Privacy Practices for Health Care Clients (Español) (pdf)

Notice of Privacy Practices for Health Care Clients Acknowledgement (Español) (pdf)

Client Grievance Form

(Print on yellow paper)

English (pdf)

Spanish (pdf)

Request for Change of Service Provider

English (pdf)

Spanish (pdf)

Contact

For questions about these documents, please contact:

Marty Marcus, LCSW
(707)565-4917
Wendy Sanders, LCSW
(707)565-4962

Back to Top | Website Help | Contact Us | Privacy Policy | Get Adobe® Reader®