Behavioral Health Staff: Forms & Policies
Graduate Medical Education: GMEC Responsibilities Policy: 26-10
Medical Psychiatric
Policy: 26-10 Graduate Medical Education: GMEC Responsibilities Policy
Attachments
Attachment A: Sponsoring Institution Organizational
Chart
Attachment B: Graduate Medical Education Committee (GMEC)
Organizational Chart
Graduate Medical Education: Vacation and Leaves of Absence Policy: 26-09
Medical Psychiatric
Policy: 26-09 Graduate Medical Education: Vacation and Leaves of Absence Policy
Graduate Medical Education: Special Review Process: 26-08
Medical Psychiatric
Policy: 26-08 Graduate Medical Education: Special Review Process
Graduate Medical Education: Policy on Resident and Fellow Access to Pharmaceutical/Vendor Representatives/Corporations: 26-07
Medical Psychiatric
Policy: 26-07 Graduate Medical Education: Policy on Resident and Fellow Access to Pharmaceutical/Vendor Representatives/Corporations
Graduate Medical Education: Non-Compete Policy: 26-06
Medical Psychiatric
Policy: 26-06 Graduate Medical Education: Non-Compete Policy
Graduate Medical Education: Transitions of Care: 26-05
Medical Psychiatric
Policy: 26-05 Graduate Medical Education: Transitions of Care
Graduate Medical Education: Accommodations of Disability Policy: 26-04
Medical Psychiatric
Policy: 26-04 Graduate Medical Education: Accommodations of Disability Policy
Quality Improvement Committee: 26-02
Administration
Policy: 26-02 Quality Improvement Committee
Attachments
Attachment A: QIC Subcommittee List and Descriptions
Therapeutic Behavioral Services (TBS): 26-01
Admission Referral
Policy: 26-01 Therapeutic Behavioral Services (TBS)
Attachments
Attachment A: TBS Referral Form (San Mateo)
Attachment B: Access UM Prior Authorization Request Form
Progress Summary
Attachment C: TBS Authorization Extension Form
Attachment D: TBS Authorization Request Workflow
Quality Management (QM) Program Description: 26-03
Administration
Policy: 26-03 Quality Management (QM) Program Description
Attachments
Attachment A : Description of Performance Monitoring
Activities
Network Adequacy Standards and Timely Treatment Access for MHPs and DMC-ODS: 25-07
Other
Policy: 25-07 Network Adequacy Standards and Timely Treatment Access for Mental Health (MHPs) and Drug Medi-Cal Organized Delivery System (DMC-ODS)
- Timely Access Key Definitions
- Timely Access Flowchart for Widgets and Reports
- Timely Access Flowchart for Discharged (SMHS)
- Timely Access Flowchart for Discharged (SUD)
- Timely Access Flowchart for New Clients (SMHS)
- Timely Access Flowchart for New Clients (SUD non-residential))
- Timely Access Flowchart for Psychiatry Requests (SMHS)
- Timely Access Referral Source Examples
- Timely Access Tracking Form PDF
- Timely Access Webinar, Part 1
- Timely Access Standard Timelines
- Timely Access Flowchart for New Clients (SUD Residential))
- Timely Access Avatar Form Screen Shots
- Timely Access Webinar, Part 2
- Read more
GME: Closures, Reductions, and Substantial Disruptions in Patient Care or Education: 25-10
Medical Psychiatric
Policy: 25-10 Graduate Medical Education: Closures, Reductions, and Substantial Disruptions in Patient Care or Education
GME: Policy On Resident And Fellow Moonlighting Activities: 25-08
Medical Psychiatric
Policy: 25-08 Graduate Medical Education: Policy on Resident and Fellow Moonlighting Activities
External Communications – Public Communications, Letterhead, Press Releases, and Media Campaign Policy: 25-06
Administration
Policy: 25-06 External Communications – Public Communications, Letterhead, Press Releases, and Media Campaign Policy
Attachments
Attachment A: BHRS Communications Policy Workflow
Attachment B: County of San Mateo Photo/Video/Audio and
Personal Narrative Consent and Release Form
Attachment C: Public Notice of Photo/Video Release for Large
Events
Credentialing and Re-Credentialing BHRS Providers: 25-04
Compliance
Policy: 25-04 Credentialing and Re-Credentialing BHRS Providers
5270 Certification Review Hearings: 25-03
Compliance
Policy: 25-03 5270 Certification Review Hearings
Attachment A: Certification Review Hearing Information
Attachment B: Certification Review Hearing Record and
Decision Form
BHRS Graduate Medical Education Policy on Recruitment, Eligibility, Selection and Appointment of Residents and Fellows: 25-02
Scope of Practice
Policy 25-02: BHRS Graduate Medical Education Policy on Recruitment, Eligibility, Selection and Appointment of Residents and Fellows
BHRS Graduate Medical Education Policy on Promotion, Renewal, and Dismissal: 25-01
Scope of Practice
Policy: BHRS Graduate Medical Education Policy on Promotion, Renewal, and Dismissal
Index of Current BHRS Policies
Other
BHRS Policy Index - (Organized by policy number)
BHRS Policy Index – (Organized by policy
category)
*Please note that this index, organized by category, is
still in the development phase and categories are not final.
Please send feedback to HS_BHRS_Policy_QM@smcgov.org
Service Verifications: 24-04
Compliance
24-04 Service Verifications: Policy
Attachments
Attachment A: Sample Verification of Services Letter
Attachment B: Sample Phone Script
Attachment C: Sample Service Verification Report
Original Policy Date: June 17, 2024
Amended: N/A
Supersedes: N/A
Provision of ICC, IHBS, and TFC Services: 24-05
Admission Referral
Policy: 24-05 Provision of ICC, IHBS, and TFC Services
Attachments
Attachment A: SMC ICC Eligibility Screening Form
Memorandum of Understanding between San Mateo Health Commission d/b/a Health Plan of San Mateo and Behavioral Health & Recovery Services
MOUs
Memorandum of Understanding between San Mateo Health Commission d/b/a Health Plan of San Mateo and Behavioral Health & Recovery Services. MOU_MHP-MCP_HPSM
Memorandum of Understanding between San Mateo Health Commission d/b/a Health Plan of San Mateo and San Mateo County Behavioral Health & Recovery Services DMC-ODS. MOU_DMC ODS-MCP_HPSM
Added 11/15/2024
San Mateo County 2025 Annual MOU Report
Emergency Procedures at BHRS Facilities for Utility/Environmental Disruptions: 24-03
Compliance
Policy 24-03: Emergency Procedures at BHRS Facilities for Utility/Environmental Disruptions Policy
23-05: County Behavioral Health Intergovernmental Transfer (IGT)
CalAIM
Policy 23-05: Policy 23-05 County Behavioral Health Intergovernmental Transfer (IGT)
New Policy: July 14, 2023
5150 Certification Review Hearing (AB 2275): 23-04
Compliance
Policy: 23-04 5150 Certification Review Hearing (AB
2275)
Attachment A: Contact Information
Attachment B: Patient Rights Advisement
Attachment C: Hearing Record and Decision Form
Utilization Management (UM), Audit, Oversight and Recoupment Standards for Substance Use Disorder (SUD) Services: 23-03
Compliance
Attachment A: CalMHSA SUD UR/Audit Tool
New Policy: February 3, 2023
Supersedes:
Policy 20-05: Utilization Management Program and Authorization of
SMHS
Utilization Management (UM) & Audit, Oversight, Recoupment Standards (SMHS): 23-02
Compliance
Utilization Management (UM) & Audit, Oversight, Recoupment Standards (SMHS)
Attachment A: CalMHSA SMHS UR/Audit Tool
New Policy: January 31, 2023
Supersedes:
Policy 20-05 Utilization Management Program and Authorization of
SMHS
Electronic Communication (Client Communication): 22-07
HIPAA
Policy : 22-07 Electronic Communication (Client Communication)
Attachments:
Attachment A: E-Communication Consent Form
Attachment B: Standards of Practice for Telehealth
Attachment C: Accessing Secure Platforms
Attachment D: Staff Contact Information Worksheet
Attachment E: Remote Services Protocol Checklist
Electronic Communications Policy (General Guidelines): 22-06
HIPAA
22-06 Electronic Communications (General Guidelines): Policy
Attachments:
Attachment A: Deidentifying Protected Health Information
Attachment B: Protocol for E-mail Usage (for staff)
Attachment C: Sending Secure E-mails
For additional guidance on electronic communication with clients, please see Policy 22-07 Electronic Communication (Client Communication).
BHRS Naloxone Policy: 22-05
AOD
Policy: 22-05 BHRS Naloxone Policy
Attachment A: BHRS Pharmacy Naloxone Log
Attachment B: Clinic/Program Naloxone Log
Attachment C: Naloxone Staff Training Tracker
Specialty Mental Health Services Provider Network (SPPN): 21-02
Clinical
Specialty Mental Health Services Provider Network (SPPN): 21-02
- Attachment A: Adult SPPN referral form
- Attachment B: Youth SPPN referral form
- Attachment C: SPPN Treatment Plan Update form
NEW POLICY: October 28, 2021
Documents established practice effective June 1, 2021
Assignment of On-Call Work for BHRS Staff Divisional: Policy 21-01
Clinical
Assignment of On-Call Work for BHRS Staff : 21-01
Original policy date: May 12, 2021
Amended: October 6, 2022
Psychiatry Residency Training Program – Moonlighting Regulations: 94-04
Medical Psychiatric
Policy: 94-04 Psychiatry Residency Training Program - Moonlighting Regulations
MHSA Issue Resolution Process: 20-10
Other
Policy: 20-10 MHSA Issue Resolution Process
MHSA Administration and Components: 20-09
Other
Policy: 20-09 MHSA Administration and Components
Attachments
Attachment A : MHSA Steering Committee Roles and
Responsibilities
Utilization Management of Inpatient Psychiatric Services: 20-06
Clinical
UM of Inpatient Psychiatric Services Policy: 20-06
Attachment A: Acknowledgment Notification Responsible | 20-06_Attachment B: Concurrent Documentation Required| Attachment C: Acknowledgment Notification Non-responsible
NEW POLICY: February 4, 2020; Technical Edit February 24, 2020;
Amended November 5, 2020
Attachment A: Technical Edit February 10, 2023
Continuity of Care for Specialty Mental Health and Drug Medi-Cal Organized Delivery System: 20-01
Clinical
Policy: 20-01 Continuity of Care for Specialty Mental Health and Drug Medi-Cal Organized Delivery System
Attachments: N/A
Original Policy Date: January 10, 2020
Amended: Renamed & Technical Edit September 4,
2024
Supersedes: N/A
Authorization of Adult Residential Services: 20-02
Admission Referral
Policy: 20-02 Authorization of Adult Residential Services
Attachments
Attachment A: Adult Residential Auth Form
Attachment B: Electronic Community Referral
Attachment C: Reauth Adult Residential Progress Summary
Resources: Process changes have occurred since this webinar consult with your BHRS Adult Team contact person Presentation |Video
Authorization of Youth Specialty Mental Health Services (SMHS): 20-04
Admission Referral
Authorization of Youth Specialty Mental Health Services (SMHS) Policy: 20-04
Attachments:
- A. TBS Authorization Form
- B. Service Authorization Request Form | Printable Version
- C. TBS Utilization Request Form
- D. TBS Assessment Extension Authorization
- E. TBS Assessment Authorization
- F. TBS Authorization Request Workflow
NEW POLICY: January 9, 2020
Attachments A, D, E: Technical Edit February 18, 2021 Attachment
F: added February 18, 2021
Presumptive Transfer: 20-03
Admission Referral
Policy: 20-03 Presumptive Transfer
Attachments
Attachment A: Referral Request for Presumptive
Transfer Child in San Mateo County (AB1299)
Medication Monitoring for Youth: 20-07
Medical Psychiatric
Medication Monitoring for Youth Policy: 20-07
NEW POLICY: January 8, 2020
Utilization Management Program and Authorization of Specialty Mental: 20-05
Compliance
UM Program: SMHS Policy: 20-05
NEW POLICY: January 9, 2020
Technical Edit July 17, 2020; Amended November 5, 2020
Provider Directory: 19-06
Compliance
Provider Directory Policy: 19-06
BHRS Directory Link https://www.smchealth.org/BHRSProviders
New Policy: December 18, 2019
Expedited Pre‐Service Organizational Determinations: 19-03
Managed Care
Expedited Pre‐Service Organizational Determinations: Policy 19-03
New Policy: August 28, 2019
Standard Pre‐Service Organizational Determinations: 19-02
Managed Care
Standard Pre‐Service Organizational Determinations: Policy 19-02
New Policy August 28, 2019
Consumer Problem Resolution & NOA: 19-01
Client Rights
Policy : 19-01 Consumer Problem Resolution & NOA
ATTACHMENTS:
- Notice of Availability
- English
- Spanish
- Chinese
- Tagalog
- Russian
- English
- Spanish
- Spanish
- Spanish
- Spanish
- Tagalog
- Tagalog
- Tagalog
- Chinese
- Chinese
- Chinese
- Chinese
- Tagalog
- Templates for reason for issuing NOABD, Why we denied your request.
- Guide to Using the AVATAR NOABD / NAR Form
- Chinese
- Chinese
- Chinese
- Chinese
- Chinese
- Chinese
- Chinese
- Chinese
- Chinese
- Chinese
- Chinese
- English
- English
- English
- English
- English
- English
- English
- English
- English
- English
- Chinese
- English
- Chinese
- English
- Chinese
- English
- Spanish
- Spanish
- Spanish
- Spanish
- Spanish
- Spanish
- Spanish
- Spanish
- Spanish
- Spanish
- Spanish
- Spanish
- Tagalog
- Tagalog
- Tagalog
- Tagalog
- Tagalog
- Tagalog
- Tagalog
- Tagalog
- Tagalog
- Tagalog
- Tagalog
- English
- Tagalog
- Chinese
- Read more
CANS & PSC-35 Implementation: Memo 01-22
Clinical
CANS & PSC-35 Implementation: Memo 01-22: CANS and PSC-35 - All Providers
Supersedes: Memo 01-18: County Mental Health Staff | Memo 02-18: Contractor Mental Health Agencies Memo 03-18: CANS & PSC-35- all providers
New Memo: June 24, 2022
Network Adequacy Standards 18-02
Compliance
Cultural Humility, Equity, CLAS: 18-01
Clinical
Policy: 18-01 Cultural Humility, Equity and Inclusion Framework; Implementation of CLAS Standards
Attachments
Attachment A: BHRS Policies Relevant to the National CLAS
Standards
Access to Services for the Organized Delivery System for Substance Use Disorder Services: 17-03
AOD
Policy: 17-03 Access to Services for the Organized Delivery System for Substance Use Disorder Services
Delegation Oversight & Audit Program: 17-02
Compliance
Delegation Oversight & Audit Program: 17-02
Attachment: A. Contractor Attestation
Amended: Technical Edits October 24, 2017; December 21,
2017;
December 18, 2019; June 14, 2024
Attachment A: Technical Edit December 18, 2019
Psychiatric Medication Consent for Voluntary Adults and Youth: 16-12
Medical Psychiatric
Psychiatric Medication Consent for Voluntary Adults and Youth
Attachment A: Consent to Take Medication
English Spanish Tagalog Chinese
Continuing Education for AOD Providers: Compliance with SUBG Restrictions and Guidelines: 16-10
AOD
Policy: 16-10 Continuing Education for Alcohol and Other Drug Treatment Providers: Compliance with Substance Abuse Prevention, Treatment, and Recovery Services Block Grant (SUBG) Restrictions and Guidelines
Americans with Disabilities Act (ADA), Section 504, and Unruh Civil Rights Act: Compliance with SUBG: 16-09
AOD
Policy: 16-09 Americans with Disabilities Act (ADA), Section 504, and Unruh Civil Rights Act: Compliance with Substance Use Prevention, Treatment and Recovery Services Block Grant (SUBG)
Attachments:
Attachment A: SUD SUBG ADA Unruh (ADP Bulletin)
Attachment B: SMC SUD Treatment Providers with Wheelchair
Accessible Facilities
Uniform Guidance: Compliance with SUBG: 16-08
AOD
Policy: 16-08 Uniform Guidance: Compliance with Substance Abuse Prevention, Treatment, and Recovery Services Block Grant (SUBG)
Payment of Last Resort – Compliance with the Substance Use Prevention, Treatment and Recovery Services Block Grant (SUBG): 16-07
AOD
Policy: 16-07 Payment of Last Resort – Compliance with the Substance Use Prevention, Treatment and Recovery Services Block Grant (SUBG)
Restrictions Guidelines: Compliance with the Substance Use Prevention, Treatment and Recovery Services Block Grant (SUBG): 16-06
AOD
Policy: 16-06 Restrictions Guidelines: Compliance with the Substance Use Prevention, Treatment and Recovery Services Block Grant (SUBG)
BHRS Lanterman-Petris-Short (LPS) 72 Hour Hold/5150 Policy and Procedures: 93-07
5150/Safety/Risk Policies
Policy: 93-07 BHRS Lanterman-Petris-Short (LPS) 72 Hour Hold/5150 Policy and Procedures
Attachments
72-Hour Holds – Authorization to Write: 97-05
5150/Safety/Risk Policies
72-Hour Holds – Authorization to Write
Attachments: None
Original policy date: 5/3/97
Amended: April 9, 2008, September 19, 2018; October 1, 2021
BHRS Mental Health Admission Materials: 05-05
Admission Referral
Policy: 05-05 BHRS Mental Health Admission Materials
Admission Policy for Clients with Criminal Justice Involvement: 92-02
Admission Referral
Policy: 92-02 Admission Policy for Clients with Criminal Justice Involvement
Attachments
Attachment A: Admission Form, Patients with Criminal Justice
Involvement
Advance Health Care Directives: 04-07
Client Rights
Amendment of Protected Health Information (PHI), Client Request: 03-09
HIPAA
Amendment of Protected Health Information (PHI), Client Request: 03-09
Attachments:
Attachment: A. Request to Amend Protected Health Information
Attachment: B. Response to Request To Amend Protected Health Information
Attachment: C. Statement of Disagreement/Request to Include Amendment Request and Denial with Future Disclosures
Attachment: D. Notification of Amendment to Protected Health Information
Application for Services and Consent to Treatment: 96-15
HIPAA
Application for Services and Consent to Treatment: 96-15
Attachments:
Application for Services and Consent to Treatment: 96-15, Attachment A, Treatment Consent & Notice of Privacy Practices: English
Application for Services and Consent to Treatment: 96-15, Attachment A, Treatment Consent & Notice of Privacy Practices: Spanish
Application for Services and Consent to Treatment: 96-15, Attachment A, Treatment Consent & Notice of Privacy Practices: Tagalog
Application for Services and Consent to Treatment: 96-15, Attachment A, Treatment Consent & Notice of Privacy Practices: Tongan
Application for Services and Consent to Treatment: 96-15, Attachment, B. Minor Client Legal Status and Implications for Consent
Application for Services and Consent to Treatment: 96-15, Attachment, C. GGRS Clients Mentally Incapable of Giving Consent
Assaults on Clients – Suspected or Reported: 01-03
5150/Safety/Risk Policies
Policy: 01-03 Assaults on Clients – Suspected or Reported
Authorization to Host: HS A-5
Administration
Hosting Authority Policy
Attachments: Authorization To Host Form (Must download file to
computer to access e-signature lines)
Previously BHRS Policy 00-07: Authorization to Host
Original policy date: 2/11/00
Amended 4/11/07; Technical Edit 7/9/14
Superseded by County Health Policy HS A-5 on 10/25/17; Amended 1/24/22
Bilingual Salary Differential -Per San Mateo County Policy: 01-08
Administration
Blood Withdrawal by Community Mental Health Nurses: 95-06
Medical Psychiatric
Change of Clinician/Provider Request, including Charitable Choice: 98-01
Client Rights
Policy: 98-01 Change of Clinician/Provider Request, including Charitable Choice
Claims Processing Guidelines and Procedures: 07-04
Financial
Policy: 07-04 Claims Processing Guidelines and Procedures
Client Access to Protected Health Information (PHI): 00-06
HIPAA
Policy: 00-06 Client Access to Protected Health Information (PHI)
Attachments:
Attachment A: Request for Access to Protected Health
Information
English Spanish Tagalog
Attachment B: Log of Requests for Access to Protected Health
Information
Client Insurance Information and Financial Participation: 03-12
Financial
Policy: 03-12 Client Insurance Information and Financial
Participation
Attachments
Attachment A: Uniform Method of Determining Ability to
Pay (UMDAP) Fee Schedule and Asset Allowance Schedule
Attachment B : Roles and Responsibilities for Client
Information and Financial Screening
Attachment C: San Mateo Mental Health Guide to Payor
Financial Information (PFI) Requirements
Attachment D: Payer Financial Information
Client Referrals: 93-12
Admission Referral
Policy: 93-12 Client Referrals
Attachments
Attachment A: Request for Self/Team Referral
Compliance and Delegation Oversight Committee: 03-16
Compliance
Policy: 03-16 Compliance and Delegation Oversight
Committee
Attachments:
Attachment A : Compliance and Delegation Oversight Committee
Charter
Documentation Requirements for all SMHS, DMC and DMC-ODS Services: 22-04
Compliance
Policy: 22-04: Documentation Requirements or all SMHS, DMC, and DMC-ODS Services
Memo 11-17: Chart Documentation Requirement Updates
Memo: Assessment & Treatment Plan Timeline Changes 4/6/16.
Confidentiality/Privacy of Protected Health Information (PHI): 03-01
HIPAA
Confidentiality/Privacy of Protected Health Information (PHI): 03-01
Attachments:
A. Declaration of Notice of Confidentiality
B. Authorization for Use or Disclosure of Health Information (Mental Health): English | Spanish | Chinese | Tagalog | Tongan | Russian
C. Authorization for the Verbal Release of Client Information (Mental Health): English | Spanish | Chinese | Russian | Tagalog | Tongan
F. Exchange of Information: Principles and Definitions
G. Exchange of Information: Guide to Sharing
H. Authorization for Use or Disclosure of Protected Health Information (AOD Services): English | Spanish | Chinese | Russian | Tagalog | Tongan
Consumer Problem Resolution Process: 03-03
Client Rights
Obsoleted by 19-01 June 24,
2019
Stipends for Individuals with Lived Experience and Family Members for Services Provided to SMC BHRS: 06-02
Client Rights
Contracts, Requests for Proposals (RFP), and Waivers of RFP Process: 97-06
Contracts
Contracts, Requests for Proposals (RFP), and Waivers of RFP Process: 97-06
Attachments:
Contracts, Requests for Proposals (RFP), and Waivers of RFP Process: 97-06, Attachment A- Contracting Methodologies
Contracts, Requests for Proposals (RFP), and Waivers of RFP Process: 97-06, Attachment B, Competitive Awards Procedure
Contracts, Requests for Proposals (RFP), and Waivers of RFP Process: 97-06, Attachment D, Public Notice
Credentialing for Independent Contracted Providers: 98-05
Managed Care
Policy: 98-05 Credentialing for Independent Contracted Providers
Attachments:
Attachment A : Provider Attestation Form
Critical Incident Reporting: 93-11
5150/Safety/Risk Policies
Policy: 93-11 Critical Incident Reporting
Attachments:
Attachment A: Incident Reporting Form
Attachment B: Breach Decision Tree
Original Policy Date: December 6, 1993
Amended: January 24, 2002, November 15,
2002, November 14, 2012, December 8, 2016, June 7, 2017, August
31, 2017; Technical Edit November 18, 2019
Supersedes: N/A
Critical Referrals: 98-15
Admission Referral
Policy: 98-15 Critical Referrals
Determining Responsibility for Involuntary Treatment and Out-of-County Services: 94-06
Admission Referral
Discharge Procedures from Acute Inpatient Providers to Community Providers: 92-01
Admission Referral
Policy: 92-01 Discharge Procedures from Acute Inpatient Providers to Community Providers
Disclosure of Protected Health Information (PHI), Minimum Necessary: 03-04
HIPAA
Disclosure of Protected Health Information (PHI), Minimum Necessary: 03-04
Attachments:
Attachment: B. Routine Requests and the Degree of Disclosure Allowed
Attachment: C. Management Information System (MIS) – Outline of Access by Function
Attachment: A. Individuals and the Conditions of their Minimum Necessary Access by Workforce Class
Disclosures of Protected Health Information (PHI) with Client Authorization: 03-06
HIPAA
Disclosures of Protected Health Information (PHI) with Client Authorization: 03-06
ATTACHMENTS:
See Policy 03-01:
Confidentiality/Privacy of Protected Health Information
(PHI)
• Attachment B: Authorization for Use or Disclosure of Protected
Health Information
• Attachment C: Authorization for the Verbal Release of Client
Information
Disclosures of Protected Health Information (PHI), Incidental: 03-05
HIPAA
Disclosures of Protected Health Information (PHI), Request for an Accounting: 03-07
HIPAA
Duty to Protect and Duty to Warn Potential Victims (Tarasoff vs. Regents of the University of California): 93-08
5150/Safety/Risk Policies
Policy: 93-08 Duty to Protect and Duty to Warn Potential Victims (Tarasoff vs. Regents of the University of California)
Education Leave/Training Guidelines: 96-06
Medical Psychiatric
Education Leave/Training Guidelines: 96-06
Attachments:
Attachment: A. Request for Educational Leave with Pay
Attachment: B&C. Request for Tuition Reimbursement (County form & Guidelines)
Attachment: D. Request for Reimbursement for Professional Dues, Fees, CME or CEU Courses, or Clinical Training Materials
Attachment: E. Educational Leave/Training Guidelines
Eligibility for Planned (non-emergency) SMC MH Services for Individuals Who Have Private Insurance: 03-13
Admission Referral
Email Use: 03-11
HIPAA
Family Inclusion Policy: 14-02
Clinical
Policy: 14-02 Family Inclusion Policy
Flexible Funds: 00-03
Clinical
Policy: 00-03 Flexible Funds
Attachments:
Attachment A : Youth Flexible Funds Application
Information
Attachment B: Child-Youth Flexible Funds Request
Authorization Form
Attachment B1: Child-Youth NMT Flexible Funds Request
Authorization Form
Attachment C: Youth Transition, Adult/Older Adult Flexible
Funds Application Information
Attachment D : Youth Transition, Adult/Older Adult Flexible
Funds Request Authorization Form
Attachment E: Supplemental Housing Funds
Flexible/Alternative Work Hours: 01-02
Administration
Retired 10/12/21
Original policy date: 7/3/01
Last review: 8/13/08
Inpatient Services to Beneficiaries of Other Counties: 00-09
Admission Referral
Superseded by UTILIZATION MANAGEMENT OF INPATIENT PSYCHIATRIC SERVICES: 20-06
Linkages between Outpatient Clinics and PES about Adult MH Clients Open to Region: 02-01
5150/Safety/Risk Policies
Policy: 02-01 Linkages between Outpatient Clinics and Psychiatric Emergency Services (PES) about Adult MH Clients Open to Region
Attachments:
Attachment A: Adult Regional Clinic/Specialty Team Unit Chief’s
Phone and Fax Numbers
Attachment B: Adult Regional Clinic/Specialty Team After Hours
Phone Numbers
Attachment C: Adult Outpatient Clinic/Specialty Team FAX of
Client Information
Policy Management, Development, and Approval Process: 08-02
Administration
Policy: 08-02 Policy Management, Development, and Approval
Process
Attachment A: BHRS Policy Development Flow Chart
Medication Authorization for Dependent Children (W&I Code, Section 300): 99-02
Medical Psychiatric
Medication Authorization for Dependent Children: 99-02
Attachments: A. JV 220 | B. JV-220-A | C. JV-220-B | D. JV-221 | E. JV-222 | F. JV 223
Original policy date: 1/12/99
Last review: 1/27/20107
Medication Monitoring: 04-08
Medical Psychiatric
Policy: 04-08 Medication Monitoring
Attachments
Attachment A: Medication Monitoring Checklist
Medication Room Management: 99-03
Medical Psychiatric
Policy: 99-03 Medication Room Management
Attachments:
Attachment A : Controlled Substance/Emergency Supply
Record
Attachment B: Record of Medication for Storage and
Removal
Attachment C: Report of Quarterly Medication Room
Inspection
Attachment D: Medical Waste Registration Application
Attachment E: Medical Waste Management Plan
Attachment F: Stock Medication Order Form
Attachment G : Long-Acting Injectable Medication
Administration
Mental Health Nurse Practitioner Protocols: 97-10
Medical Psychiatric
Credentialing and Re- Credentialing Providers: 19-08
Compliance
Credentialing and Re- Credentialing Providers Policy 19-08
Attachments:
- A. Contractor Monthly Credentialing Verification Spreadsheet
- B. Attestation BHRS Staff and On-site Contractors
- C. Attestation Contractors
- D. Acknowledgment of Receipt (BHRS Policies)
- E. BHRS Form 700 – Contractor Agency
- F. Health Policy A-14: Conflict of Interest, Incompatible Activities and Outside Employment for Employees
- G. Health Policy A-14 (Attachment 1): Employee Statement
- H. BHRS Attestation for Outside Employment for Health Policy A-14
Original Policy Date: December 31, 2019,
Amended:
Technical Edits January 9, 2020, November 5, 2020, June 26,
2023; Amended June 26, 2024
Attachment F: updated June 7, 2021
Attachment G: updated February 17, 2023
Attachment H: added June 26, 2023
Required Policies For New Staff to Review
BEHAVIORAL HEALTH CONFIDENTIALITY
- Policy 00-06 Client Access to Protected Health Information
- Policy 03-01 Confidentiality/Privacy of Protected Health Information
- Policy 03-11 E-Mail Use
- BHRS Compliance Plan
- BHRS Code of Conduct
- Policy 91-05 Compliance with Documentation Standards
CLINICAL STAFF ONLY
- Policy 03-02 Notice of Privacy Practice
- Policy 03-04 Disclosure of Protected Health Information, Minimum Necessary
- Policy 03-05 Disclosure of Protected Health Information, Incidental
- Policy 03-06 Disclosure of Protected Health Information with Client Authorization
- Policy 03-07 Disclosure of Protected Health Information, Request for an Accounting
- Policy 03-08 Restrictions on Use or Disclosure of Protected Health Information Client Request
- Policy 03-09 Amendment of Protected Health Information, Client Request
Notice of Action: 04-10
Client Rights
Obsoleted by 19-01 June 24,
2019
Notice of Privacy Practices: 03-02
HIPAA
Notice of Privacy Practices Policy: 03-02
Attachment A: Summary of Privacy Practices: English | Spanish | Chinese | Tagalog | Tongan | Russian
Attachment B: Consent to Treatment & Acknowledgement of Receipt of Notice of Privacy Practices: English | Tagalog | Spanish | Tongan | Chinese | Tagalog | Russian
Outpatient Services to Beneficiaries of Other Counties: 07-02
Managed Care
Policies: 07-02 Outpatient Services to Beneficiaries of Other Counties
Petty Cash Procedures: Policy 13-02
Financial
Pharmaceutical/Vendor Representatives Access and Accountability: 04-06
Medical Psychiatric
Practice Guidelines: 08-03
Clinical
Policy: 08-03 Practice Guidelines
Attachments:
Attachment A: BHRS Practice Guidelines Manual for SMHS and
DMC-ODS
Practice Standards (Scope of Practice): 93-10
Clinical
Policy: 93-10 Practice Standards (Scope of Practice)
Attachments:
Attachment A: Scope of Practice Matrix
Original policy date: December 13, 1993
Amended: October 29, 1998, March 9, 2005;
Technical edit February 10, 2010; Attachment A: Technical
edit June 18, 2024
Supersedes: N/A
Private Provider Contracts – Language Capabilities: 99-09
Administration
Policy: 99-09 Private Provider Contracts – Language Capabilities
Procedures for Non-SMMC Inpatient Psychiatric Treatment: 99-08
Admission Referral
Superseded by UTILIZATION MANAGEMENT OF INPATIENT PSYCHIATRIC SERVICES: 20-06
Provider Contracts: 98-03
Managed Care
Superseded by policy 19-07
Providing Services to Persons with Physical Disabilities: 10-01
Administration
Policy: 10-01 Providing Services to Persons with Physical Disabilities
Psychiatric Utilization Management Committee: 92-12
Admission Referral
Psychological Testing – Referral Protocol: 98-18
Admission Referral
Policy: 98-18 Psychological Testing – Referral Protocol
Attachments
Attachment A: Referral for Psychological Evaluation
Quality Improvement Compliance Review of Outpatient Provider Services: 98-11
Compliance
Quality Improvement/Peer Review of Cases in which Death has Resulted from Suicide, Homicide or Suspicious Causes: 00-10
5150/Safety/Risk Policies
Referral Procedures (Clinical) – Unique Circumstances: 99-07
Admission Referral
Policy: 99-07 Referral Procedures (Clinical) – Unique Circumstances
Attachments
Attachment A: Request for Referral to Unique Clinical Service
Referral Standards – County or County Contract 24-Hour Treatment Facilities: 91-17
Admission Referral
Policy: 91-17 Referral Standards – County or County Contract 24-Hour Treatment Facilities