| Attachment 1A: |
Assessment/Care Plan: Initial, English |
| Attachment 1B: |
Assessment/Care Plan: Initial, Spanish |
| Attachment 2: |
Treatment Extension/Change Request |
| Attachment 3: |
Discharge Summary |
| Attachment 4: |
Medication Declaration Form |
| Attachment 5: |
Referral for Psychological Testing |
| Attachment 6: |
Psychological Testing Authorization Request |
| Attachment 6A: |
Consent to Treat, English |
| Attachment 6B: |
Consent to Treat, Spanish |
| Attachment 7A: |
Authorization for Treatment of Minors, English |
| Attachment 7B: |
Authorization for Treatment of Minors, Spanish |
| Attachment 8: |
Quarterly Report Authorization |
| Attachment 9A: |
ACT Release of Information, English |
| Attachment 9B: |
ACT Release of Information, Spanish |
| Attachment 10A: |
Adult Medical History, English |
| Attachment 10B: |
Adult Medical History, Spanish |
| Attachment 11A: |
Child's Medical History, English |
| Attachment 11B: |
Child's Medical, Spanish |
| Attachment 12: |
AEVS |
| Attachment 13: |
Incident Report Form |
| Attachment 14: |
Adverse Incident Report Form |
| Attachment 15: |
CSI Data Collection |
| Attachment 16: |
Provider Referral Request Form |
| Attachment 17: |
Certification of Integrity |
| Attachment 18A: |
TBS Referral Form |
| Attachment 18B: |
TBS Referral Form, Spanish |
| Attachment 19: |
TBS Informed Consent Form |
| Attachment 20A: |
TBS Consent for Services Form, English |
| Attachment 20B: |
TBS Consent for Services Form, Spanish |
| Attachment 21: |
TBS Eligibility Criteria Form |
| Attachment 22: |
TBS Procedure for Section B TBS Eligibility Criteria |
| Attachment 23: |
Medi-Cal Eligibility Verification |
| Attachment 24: |
Psychiatric Treatment Authorization Form |
| Attachment 25: |
Medication Guidelines |
| Attachment 26: |
IMD Psychiatric Treatment Authorization Form |
| Attachment 27: |
Referral for Services FFA or Group Home |
| Attachment 28: |
SB785 |
| Attachment 29: |
Informing Materials Order Form |
| Attachment 30A: |
Riverside County Guide to Medi-Cal Mental Health Services, English |
| Attachment 30B: |
Riverside County Guide to Medi-Cal Mental Health Services, Spanish |
| Attachment 31A: |
HIPAA Form, English |
| Attachment 31B: |
HIPAA Form, Spanish |
| Attachment 32A: |
Appeal & Grievance Procedure/Request Form, English |
| Attachment 32B: |
Appeal & Grievance Procedure/Request Form, Spanish |
| Attachment 33A: |
Your Right to Make Decisions About Medical Treatment, English |
| Attachment 33B: |
Your Right to Make Decisions About Medical Treatment, Spanish |
| Attachment 34A: |
Medi-Cal Beneficiaries Flyer, English |
| Attachment 34B: |
Medi-Cal Beneficiaries Flyer, Spanish |
| Attachment 35A: |
Ombudsman Poster, English |
| Attachment 35B: |
Ombudsman Poster, Spanish |
| Attachment 36A: |
Consumer Grievance/Appeal/State Fair Hearing Information, English |
| Attachment 36B: |
Consumer Grievance/Appeal/State Fair Hearing Information, English |
| Attachment 37: |
Grievance Log |
| Attachment 38A: |
Advance Health Care Directives, English |
| Attachment 38B: |
Advance Health Care Directives, Spanish |