PRINTABLE DOCUMENTS
Onset of Services
At the onset of services, clients will be provided the following documents regarding Monterey County Behavioral Health (MCBH) services. Clients will receive an appropriate amount of education regarding the content of these documents so clients and their families can make informed decisions about MCBH services.
Authorization for Use, Exchange, and or Disclosure of Confidential Behavioral Health Information
- Authorization for Use, Exchange, and or Disclosure of Confidential Behavioral Health Information WITHIN - Spanish
- Authorization for Use, Exchange and or Disclosure of Confidential Behavioral Health Information WITHIN - SAMPLE
- Authorization for Use, Exchange, and or Disclosure of Confidential Behavioral Health Information - General - Spanish
- MCBH Authorization for Use, Exchange, and-or Disclosure of Confidential Behavioral Health Information – MDT (Multi-Disciplinary Teams) - Spanish
- MCBH Notice of Privacy Practice - English - Spanish
- MCBH Minor Consent- English- Spanish
- MCBH Informed Consent - English- Spanish
- MCBH Consumer Rights - English- Spanish
Problem Resolution Process / Proceso De resolución de disputas
- Problem Resolution Brochure / Proceso de Resolución de Problemas - Folleto
- Problem Resolution Process / Proceso de Resolución de Problemas
- Grievance Form / Formulario de Quejas Formales
- Appeal Form / Formulario de Apelación
- Change of Clinician Form / Cambio de Medico Clinico
- Unlicensed Clinician Consent (revised Jan 31 – This is a bilingual form)
Provider Directories / Resource Guide
Beneficiary Handbook
- Notice of Significant Changes to the Beneficiary Handbook
- Monterey County Mental Health Plan (MHP) Beneficiary Handbook Specialty Mental Health Services
- Manual del Beneficiario - Servicios Especializados de Salud Mental
- Monterey County Drug Medi-Cal Organized Delivery System Beneficiary Handbook Substance Use Disorder Services
- Manual del Beneficiario de Servicios para Trastornos de Consumo de Sustancias
Emergency Department Access
Click to see all Documents
Other Printable Documents
Click to view all
- Adverse Childhood Experiences ACES – English/Spanish
- PEARLS Pediatric ACEs and Related Life Events
- Authorization for use or disclose of protected health information Prop 47
- Quarterly Assessment Form
- Key Event Tracking Form
- Partnership Assessment Form
- Mobile Response Team (MRT) Information Flyer
- Mobile Response Team (MRT) Referral Form
- Mobile Response Team (MRT) for Youth
- Notice to Clients BBS Complaints (this is a bilingual document)
- Electronic Communication Consent: English / Spanish
- Pediatric Symptom Checklist (PSC35) - English / Spanish
- Application for Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment
- Inpatient ICD 10 Included
- Outpatient ICD 10 Included
- Telehealth Consent Acknowledgement: English / Spanish
- Collaborative Case Conference – Request for QI Consultation
- Authorization to Bill Private Insurance or Medicare –English / Spanish
- Caregivers Authorization Affidavit – English / Spanish
- Consent to Photograph/Videotape – English / Spanish
- Excuse Letter revised Jan 2017
- Permission for Outings Medical Treatment – English / Spanish (also used for transporting clients)
- Safety Concerns Regarding Client (Letter)
- Treatment Plan Participation Consent – (This is a bilingual form)
- Approved Abbreviations
- 123 Unusual Incident Reporting Policy
- 306 Duty to Warn – English / Spanish (Must use Adobe Reader to open)