BHRS Doc Owner: Quality Management

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Provider Selection and Retention (Mental Health Network of Care): 19-07
Administration

Policy: 19-07 Provider Selection and Retention (Mental Health Network of Care)

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

ADA Standards for Independent Professional Contractors: 98-17
Managed Care

Policy: 98-17 ADA Standards for Independent Professional Contractors

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Subpoenas to Release Records: 96-14
HIPAA

Policy: 96-14 Subpoenas to Release Records

Attachment A: Subpoena Review Checklist
Attachment B : Sample Cover Letter for Forwarding Records per Appropriate Subpoena and Release
Attachment C : Sample Letter When No Release Accompanies Subpoena and All Documents Are Being Returned
Attachment D: Sample Letter for Returning Subpoena Previously Responded To

Additional Reference Materials
How to print an Avatar Chart for records release

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Shredding of Client Material–Confidentiality: 01-09
HIPAA

Policy: 01-09 Shredding of Client Material–Confidentiality

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Restrictions on Use or Disclosure of Protected Health Information (PHI), Client Request: 03-08
HIPAA

Policy: 03-08 Restrictions on Use or Disclosure of Protected Health Information (PHI), Client Request

Attachment A: Request for Special Restriction on Use or Disclosure of Protected Health Information
Attachment B: Response to Request for Special Restriction on Use or Disclosure of Protected Health Information

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Restricted Material in Client Chart (Formerly Chart Organization): 93-13
HIPAA

Policy: 93-13 Restricted Material in Client Chart (Formerly Chart Organization)

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Research Policies and Procedures: 95-02
HIPAA

Policy: 95-02 Research Policies and Procedures

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Psychotherapy Notes: 03-10
HIPAA

Policy: 03-10 Psychotherapy Notes

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Notice of Privacy Practices: 03-02
HIPAA

Policy: 03-02 Notice of Privacy Practices

Attachment A: Summary of Privacy Practices Chinese I Russian | Spanish | Tagalog | Tongan

Attachment B: Consent to Treatment & Acknowledgement of Receipt of Notice of Privacy Practices Chinese I Russian I Spanish I Tagalog |Tongan | Tagalog

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Email Use: 03-11
HIPAA

Email Use: 03-11
Attachments:
Email Use: 03-11, Attachment: A. GroupWise Security Directions
Email Use: 03-11, Attachment: C. Protocol for Email Usage
Email Use: 03-11, Attachment: D. Instructions for Use of Tumbleweed Encryption Process

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Disclosures of Protected Health Information (PHI), Request for an Accounting: 03-07
HIPAA

Policy: 03-07 Disclosures of Protected Health Information (PHI), Request for an Accounting

Attachment: A: Request for an Accounting of Disclosures
Attachment: B: Response to Request for an Accounting of Disclosures
Attachment: C: Log of Accountable Disclosures

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Disclosures of Protected Health Information (PHI), Incidental: 03-05
HIPAA

Policy: 03-05 Disclosures of Protected Health Information (PHI), Incidental

Attachment A: Index of HIPAA-Related Policies

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Disclosures of Protected Health Information (PHI) with Client Authorization: 03-06
HIPAA

Policy: 03-06 Disclosures of Protected Health Information (PHI) with Client Authorization

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

BHRS Policies June 26, 2016 BHRS Doc Owner: Quality Management

Disclosure of Protected Health Information (PHI), Minimum Necessary: 03-04
HIPAA

Policy: 03-04 Disclosure of Protected Health Information (PHI), Minimum Necessary

Attachment A: Individuals and the Conditions of their Minimum Necessary Access by Workforce Class
Attachment B: Routine Requests and the Degree of Disclosure Allowed
Attachment C: Management Information System (MIS) – Outline of Access by Function

BHRS Policies June 25, 2016 BHRS Doc Owner: Quality Management

Confidentiality/Privacy of Protected Health Information (PHI): 03-01
HIPAA

Policy: 03-01 Confidentiality/Privacy of Protected Health Information (PHI)

BHRS Policies June 24, 2016 BHRS Doc Owner: Quality Management

Application for Services and Consent to Treatment: 96-15
HIPAA

Policy: 96-15 Application for Services and Consent to Treatment

Attachment A: Consent to Treatment & Acknowledgement of Receipt of NPP
Spanish I Tagalog I Tongan
Attachment B: Minor Client Legal Status and Implications for Consent
Attachment C: GGRC Clients Mentally Incapable of Giving Consent

BHRS Policies June 24, 2016 BHRS Doc Owner: Quality Management

Amendment of Protected Health Information (PHI), Client Request: 03-09
HIPAA

Policy: 03-09 Amendment of Protected Health Information (PHI), Client Request

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

BHRS Policies June 24, 2016 BHRS Doc Owner: Quality Management

Quality Improvement Compliance Review of Outpatient Provider Services: 98-11
Compliance

Policy: 98-11 Quality Improvement Compliance Review of Outpatient Provider Services

Attachment A: Private Provider Office Visit

BHRS Policies June 24, 2016 BHRS Doc Owner: Quality Management

Delegation of Credentialling, recredentialling, Recertification or Reappointment of Individual Practitioners: 98-09
Compliance

BHRS Policies June 24, 2016 BHRS Doc Owner: Quality Management

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

BHRS Policies June 24, 2016 BHRS Doc Owner: Quality Management

Agency Provider Certification – Medi-Cal: 98-12
Compliance

Policy: 98-12 Agency Provider Certification - Medi-Cal
Attachment A: Medi-Cal Site Re/Certification Tool & Summary

BHRS Policies June 24, 2016 BHRS Doc Owner: Quality Management

Policy Memo Assessment & Treatment Plan Timeline Changes 4-6-16
Clinical

Policy Memo Assessment & Treatment Plan Timeline Changes 4-6-16

BHRS Policies June 23, 2016 BHRS Doc Owner: Quality Management

Notice of Action: 04-10
Client Rights

Obsoleted by 19-01 June 24, 2019

BHRS Policies June 23, 2016 BHRS Doc Owner: Quality Management

Consumer Problem Resolution Process: 03-03
Client Rights

Obsoleted by 19-01 June 24, 2019

BHRS Policies June 23, 2016 BHRS Doc Owner: Quality Management

Change of Clinician/Provider Request, including Charitable Choice: 98-01
Client Rights

Policy: 98-01 Change of Clinician/Provider Request, including Charitable Choice

BHRS Policies June 22, 2016 BHRS Doc Owner: Quality Management

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

BHRS Policies June 21, 2016 BHRS Doc Owner: Quality Management

Waiver/Registration in Lieu of License: 99-04
Administration

Policy: 99-04 Waiver/Registration in Lieu of License

Attachment A: Request for Waiver of Licensure
Attachment B: Notice of Professional Responsibility to Maintain Current Clinical License
Attachment C: Procedures for Verification of Licensing and Registrations
Attachment D: CA HHSA DHCS Mental Health Professional Licensing Waiver Request

BHRS Policies June 21, 2016 BHRS Doc Owner: Quality Management

Critical Incident Reporting: 93-11
5150/Safety/Risk Policies

Policy: 93-11 Critical Incident Reporting

Attachment A: Incident Reporting Form
Attachment B: Breach Decision Tree

BHRS Policies June 21, 2016 BHRS Doc Owner: Quality Management

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