Policy: 98-17 ADA Standards for Independent Professional Contractors
Policy: 96-14 Subpoenas to Release Records
Attachments:
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
Restrictions on Use or Disclosure of Protected Health Information (PHI), Client Request: 03-08
Attachments:
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
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
Policy: 03-05 Disclosures of Protected Health Information (PHI), Incidental
Attachment A: Index of HIPAA-Related Policies
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
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
Policy: 03-01 Confidentiality/Privacy of Protected Health Information (PHI)
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
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
Policy: 22-04: Documentation Requirements or all SMHS, DMC, and DMC-ODS Services
Policy: 98-12 Agency Provider Certification -
Medi-Cal
Attachment A: Medi-Cal Site Re/Certification Tool & Summary
Obsoleted by 19-01 June 24,
2019
Obsoleted by 19-01 June 24,
2019
Policy: 98-01 Change of Clinician/Provider Request, including Charitable Choice
Policy: 08-02 Policy Management, Development, and Approval
Process
Attachment A: BHRS Policy Development Flow Chart
Policy 99-04 Waiver/Registration in Lieu of License: Policy
Attachments
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
Policy: 93-11 Critical Incident Reporting
Attachment A: Incident Reporting Form
Attachment B: Breach Decision Tree
Policy: 01-03 Assaults on Clients – Suspected or Reported
Policy: 00-06 Client Access to Protected Health Information (PHI)
Attachment A: Request for Access to Protected Health Information
Spanish I Tagalog
Attachment B: Log of Requests for Access to Protected Health
Information