E\\y\Fz0\.S=3H!C 9 *CASES IN SAN BERNARDINO COUNTY* Please review the following San Bernardino County sample forms: Form CFS 2w -Grievance Procedures Regarding Placement, Care and Removal of Children Form CFS 7D - Notice of Removal and Grievance Review Request (fill out second page to request a grievance review hearing). endstream endobj startxref Request Public Records Step 2: Fill out your forms completely. Child Abuse Hotline for San Bernardino County is 1 (800) 827-8724 Child Protective Services (CPS) Hotlines: CPS Hotlines for all 58 counties in California. Easily fill out PDF blank, edit, and sign them. Covering 20,105 square miles, San Bernardino County is Americas largest county and a diverse public service organization governed by an elected Board of Supervisors and serving a community of nearly 2.2 million residents. f It looks like your browser does not have JavaScript enabled. In cases of an immediate emergency, always call 9-1-1 for Law Enforcement intervention. 0 k f Helps at-risk children by improving communication, planning, coordination and collaboration between child serving agencies. Box 1359 Susanville, CA 96130-1359 Website Lassen County Health & Social Services Agency Ms. Barbara Longo, Director P.O. 909-484-7667. Reporting Medical Conditions and Communicable Diseases, Pill Organizers for DBH Clients (11/06/2015), ICD-10 Diagnosis and Procedure Code Transition, State Requirements for Treatment Authorization Requests, Electrical Safety: Personal Appliances (04/11/2014), Medication Policy and Procedure (11/20/2013), Prepaid Debit Cards/Bus Pass Continuous Written Log, Use of Electronic Signatures (04/22/2010), Use of Episode Closing Codes (03/02/2009), IN 15-01 Non-use of Blood Glucometers (06/02/2015), IN 13-01 Disclosure of Ownership (03/18/2013). Services. 0 K t the san bernardino county sheriff's department, in partnership with california state university of san bernardino and california baptist university, provides evidence-based interventions for inmates to improve family relations, mitigate factors leading to self-destructive life patterns, reduce recidivism, and promote overall healthy functioning 238 0 obj <>stream Phone : 909.384.9233 Phone : 800.827.8724 Code Enforcement Hotline The Code Enforcement Division of the Land Use Services Department receives complaints regarding land use, zoning, housing, public nuisances, vehicle abatement, and vegetation or fire hazard abatement. 0.749023 g The San Bernardino County Department of Child Support Services determines paternity, establishes and enforces child support orders, and secures payments to assist the financial and medical needs of their children. Submit the original + 2 copies of ALL the completed paperwork to the clerk's office in San Bernardino at 247 W. 3rd Street, 2nd Floor. H*2T0T037U03U(J for appropriate follow-up and related document completion. Our Family Court division is committed to the processing and management of all domestic matters with integrity, sensitivity and timeliness. H237402VH2P0P007 *{Dt8P *7,Jccd0%m3lz%tDE}vdYiBiplo+4 Please enable scripts and reload this page. endstream endobj 45 0 obj <>/Subtype/Form/Type/XObject>>stream The Social Security Administration (SSA), Office of the Inspector General (OIG). Get ready-made fillable templates for faster form filing and decrease human errors. If you are interested becoming a volunteer and working with social workers at CFS, please apply at: http://hss.sbcounty.gov/VIP/default.asp VIP CFS brochure 2019.pdf You may be trying to access this site from a secured browser on the server. 1435 0 obj <>/Encrypt 1346 0 R/Filter/FlateDecode/ID[<335AAE7A7B830041B320609C06D4D458><59DEEA9921E0A542ADF5998D03769A5E>]/Index[1345 242]/Info 1344 0 R/Length 160/Prev 807907/Root 1347 0 R/Size 1587/Type/XRef/W[1 3 1]>>stream DV, child abuse, sex offender classes Youth Hope, Inc. 255 N. "D" St, Suite 302 San Bernardino 92401 (909)567-2808 Family Service Agency 1661 North "E" Street San Bernardino 92405 (909) 886-6737 Adult classes now offered $20 per class *Contact if Bilingual Services needed Precious Life CES 445 S. Arrowhead Ave Ste. Consolidation of Electronic Signature (E-Signature). It is designed to resolve disagreements arising from divorce and legal separation, including provisions for the care of children. Read the instructions on the back of the form or on the web site for information on how to fill it out. Read more at CountyWire. SAN BERNARDINO COUNTY CHILD AND FAMILY SERVICES - CHILD PROTECTIVE SERVICES The program provides child protective services for San Bernardino County. H*2T0T0W0332U(J Mental Health and Alcohol and Drug Services Agency Evaluation, Timely Access Notice (NOABD) (Vietnamese), Mental Health Plan (MHP) to Medi-Cal Plan (MCP) Referral Form For Non Open Cases, Financial Liability Notice (NOABD) (Spanish), Financial Liability Notice (NOABD) (Mandarin), Financial Liability Notice (NOABD) (Vietnamese), myAvatar Program Assignment (Mental Health), myAvatar Program Assignment (Mental Health)(Spanish), myAvatar Initial Contact Form (Mental Health, myAvatar Initial Contact Form (Mental Health) (Spanish), Authorization to Release Protected Health Information (PHI), Authorization to Release Protected Health Information (PHI) (Spanish), Authorization to Release Protected Health Information (PHI) (Vietnamese), Code of Conduct and Code of Conduct Acknowledgement, Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices, Certification Review Hearing Waiver of Presence, Outpatient Treatment Reauthorization Request for Adults, List of Disclosures of Protected Health Information (PHI), Consent for Outpatient Treatment (Spanish), Consent for Outpatient Treatment (Vietnamese), Medical Care Authorization for Minor (Spanish), Consent for Sound and/or Photographic Recordings, Consent for Sound and/or Photographic Recordings (Spanish), Consent to Record and/or Photograph and Authorization for Use or Disclosure, Consent to Record and/or Photograph and Authorization for Use or Disclosure (Spanish), Conflict of Interest Disclosure Statement, Access to Medical Records Request (Spanish), Response to Request to Access Medical Records, Response to Request to Access Medical Records (Spanish), Request to Amend Protected Health Information (PHI), Request Request to Amend Protected Health Information (PHI) (Spanish), Response to Request to Amend Protected Health Information (PHI), Response to Request to Amend Protected Health Information (PHI) (Spanish), Internal Tracking of Request to Access Medical Records, Release of Information: Patients Right of Access to His/Her Own Medical Record, Release of Information: Patients Right of Access to His/Her Own Medical Record (Spanish), Advance Health Care Directive (Brochure) (Spanish), Advance Health Care Directive (Brochure) (Vietnamese), Privacy and Security Agreement Confidentiality Statement, Ineligible Persons Policy Acknowledgement and Attestation, Attestation Regarding Completion of Sanction Checks, Electronic Signature Agreement and E-Signature and Provider Signature List, DBH & BBS Complaint Notifications to Clients (8-20), DBH & BBS Complaint Notifications to Clients (8-20) (Spanish), myAvatar Policy/Procedure Acknowledgement Form, Patients Rights Grievance Form (Spanish), Patients Rights Office Grievance Appeal Form, Patients Rights Office Grievance Appeal Form (Spanish), Request for Restriction of Confidential Communication, Request for Restriction of Confidential Communication (Spanish), Response to Request for Restriction of Confidential Information, Response to Request for Restriction of Confidential Information (Spanish), Grievance and Appeal Timely Resolution Notice, Grievance and Appeal Timely Resolution Notice (Spanish), Adult (21+) ASAM Triage Level of Care Screening, Consent for SUD Care Coordination Services (English), Termination of Provider Notice Template_Spanish, Receipt of Grievance Acknowledgement Letter, Receipt of Grievance Acknowledgement Letter (Spanish), Grievance Investigation Supplemental Response Form, Pre-Licensed/Out-of-State Licensed Psychologists Statement of Awareness for Continued Employment, Non-Medication Resource Log and Instructions, Emotional Support Animal Clinical Documentation Policy, DMC-ODS Requirements for period 2022-2026, Documentation Requirements for all SMHS DMC and DMC-ODS Services, Clinical Supervision for Pre-Licensed Psychologists, Request to Change the DBH Websites Policy (BOP3047), Request to Change the DBH Websites Procedure (BOP3047-1), Adult System of Care, Intensive and Aggressive Case Management, and ACSP Coordinated Services, Reporting Dependent Adult/Elder Abuse and Neglect Policy, Reporting Dependent Adult/Elder Abuse Procedure, Adult System of Care Out-of-County Placement Policy, DBH Alcohol and Other Drug (AOD) Programs Counselor Certification Policy, Alcohol and Drug Services Code of Professional Conduct Policy, Medication Policy for Clients Seeking Alcohol and Drug Treatment Services, Alcohol and Drug Services (ADS) Youth Treatment Policy, Alcohol and Drug Services (ADS) Perinatal Treatment Policy, Admission Preference and Interim Services Policy, Admission Preference and Interim Services Procedure, Expenditure of the Substance Abuse Prevention and Treatment Block Grant Policy, Substance Use Disorder Medication Safety and Effectiveness Policy, Substance Use Disorder Service Utilization Policy, Substance Use Disorder and Recovery Services Coordination of Care Policy, Substance Use Disorder and Recovery Services Coordination of Care Procedure, Post Client Satisfaction Survey Procedure, Substance Use Disorder and Recovery Services Residential Prior Authorization Policy, Case Management Services for Child and Adolescent Clients, Providing Services to Foster Care, Adoption Assistance Program (AAP) and Kinship Guardianship Assistance Payment (KinGAP) Children Placed Out-of County Policy, Providing Services to Foster Care Children Placed Out-of-County Procedure, Providing Services to Adoption Assistance Program (AAP) and Kinship Guardianship Assistance Payment (KinGAP) Children Placed Out-of County Procedure, Childrens Fund Immediate Need Voucher Policy, Childrens Fund Immediate Need Voucher Procedure, Consent to Treat a Minor: Procedures for Parents/Legal Guardians, Consent to Treat a Dependent Minor Procedure, Clinic Responsibility for Processing Client Registration, PFI, CDI, Charge Data Invoice (CDI) Process Procedure, Treatment of DBH Employees by DBH Facilities, Acknowledgement of Abuse Reporting Duties Policy, Clinical Supervision for Licensure AMFT, ACSW, APCC, Admission Standards for Penal Code Misdemeanor Violations, Out-of-County Access for Mental Health Services, Waiver of Consumers Responsibility to Pay for Medications, Authorization and Designation Pursuant to the Lanterman-Petris-Short (LPS) Act, Duty to Warn and Protect Third Parties in, Duty to Warn and Protect Third Parties in Response to a Client Threat (Tarasoff) Procedure, Day Treatment Weekly Charting in Staff Meetings, Confidentiality When Dealing with Client Support Persons, Clients with Physical Medical Conditions Policy, Transformational Collaborative Outcomes Management (TCOM) Policy, Transformational Collaborative Outcomes Management (TCOM) Procedure, Client Notice Regarding Termination of Provider Procedure, Sending Confidential Information by Facsimile, Medical Record Security Policy for Outpatient Services, Confidentiality of Protected Health Information (PHI), Unauthorized Access of Confidential Medical Records, Medical Records Requiring Special Handling, Medical Records Requiring Special Handling Procedure, HIPAA Notice of Privacy Practices (NOPP) Policy, Authorization to Release Protected Health Information (PHI) Procedure, Trafficking Victims Protection Act of 2000, Compliance Verification, Monitoring and Auditing Policy, Security of Protected Electronic Health Information Policy, Access and Amendment of Medical Records Policy, Patients Rights Inpatient Grievance Process, Patients Rights Outpatient Grievance Process, HIPAA National Provider Identifier (NPI) Policy, HIPAA National Provider Identifier (NPI) Procedure, Right to Request Alternative Means of Communication Protected Health Information Policy, Medi-Cal Eligibility Data Systems (MEDS) Policy, Transportation of Protected Health Information (PHI) Policy, Transportation of Protected Health Information (PHI) Procedure, Non-Discrimination of Clients (Affordable Care Act) Policy (COM0953) Rev. Form Number Description Revised Date; SB-598: Settlement Conference Brief: 09/17/13: SB-12039: Stipulation And Order On Request For Order: 11/05/12: SB-19447 Substance Use Disorder and Recovery Services Policy, Substance Use Disorder and Recovery Services Procedure, Naloxone Intranasal Distribution Procedure, Client Tuberculosis (TB) Testing and Services Policy, Client Tuberculosis (TB) Testing and Services Procedure, myAvatar Electronic Health Records Policy, myAvatar User Account Creation and Reinstatement Procedure, myAvatar User Account Modification Procedure, myAvatar User Account Deactivation Procedure, Criteria for Beneficiary Access to SMHS Medical Necessity and other Requirements, No Wrong Door for Mental Health Services Policy, Revised Mental Health Co-Staffing Chart Documentation a, Personal Protective Equipment (PPE) for DBH Programs, Quality Management Chart Documentation Guidance due to, New Classification of Other Qualified Providers, Coronavirus (COVID-19) Information for DBH Workforce, Mental Health Consumer Perception Survey Spring 2019, DMC-ODS UCLA Treatment Perception Survey-October 2019, Notice of Changes to EPSDT Data Collection Requirements, Editing Notice of Adverse Benefit Determination (NOABD). If you need CPS help in California, contact Christopher R. Abernathy, APLC, a local practice in San Bernardino, for legal representation. . Take a look back at San Bernardino Countys major accomplishments in 2022, Homeless to Home, a road to self-sufficiency. endstream endobj 37 0 obj <>/Subtype/Form/Type/XObject>>stream Childrens Interagency Authorization to Exchange Confidential Health Information (PHI) Superseded by COM025_E, Childrens Interagency Authorization to Exchange Confidential Health Information (PHI) (Spanish) Superseded by COM025_S, Therapeutic Behavioral Services Service Assessment, Therapeutic Behavioral Services Risk Assessment, Therapeutic Behavioral Services Referral Form, Childrens Interagency Authorization to Exchange Confidential Health Information (PHI), Childrens Interagency Authorization to Exchange Confidential Health Information (PHI) (Spanish), Child/Adolescent Psychiatric Evaluation and Update, Child/Adolescent Clinical Assessment-CANS-SB, Request to Waive Consumers Responsibility to Pay for Medications, Caregivers Authorization Affidavit (Spanish), Request for Verification of Veterans Status for Mental Health and/or Substance Abuse Services, Consent and Authorization to Exchange Confidential Information for Veterans Status, Medication Support Services Plan (Spanish), Release and Hold Harmless Agreement (Spanish), Interdisciplinary Care Team (ICT) Referral Form, Annual Psychiatric Assessment Review Form, Guidelines for Completing Referral Summary for Referral to Managed Care Plan (MCP) Attachment, Tier Transition Letter Attachment II (Spanish), Beneficiary Nondiscrimination Notice (Spanish), Delivery System Notice (NOABD) (Vietnamese), Delivery System Notice (NOABD) (Mandarin), QM030_S Modification Notice (NOABD) (Spanish), Change of Provider Request Form (Spanish). Requests may be submitted by completing the Request for Judicial Administrative Records Form and sending it to the Court by e-mail or U.S. Mail. To Report Child Abuse San Bernardino County residents can dial 2-1-1 to anonymously report if they suspect a child is being abused. County Job Descriptions and Salaries 0 0 8.25 9 re California Family and Domestic Violence Referral Directory. H*2T0T037U03U(J Child Support Process Understanding Child Support DCSS Services Step-by-Step Process for Child Support Child Support Process Forms Within the State of California you may call toll free 1 (800) 344-6000. CFS 125 CPS (1/13) SAN BERNARDINO COUNTY CHILDREN and FAMILY SERVICES REPORT OF MEDICAL / DENTAL EXAM FOR HEALTH PASSPORT UPDATE FAX or RETURN in the POSTPAID ENVELOPE FFA must give original to social worker or PHN PUBLIC HEALTH NURSE . The Job of the County of San Bernardino is to create a county in which those who reside and invest can prosper and achieve well-being. The Court Executive Office's hours are 8:00 a.m. to 5:00 p.m., Monday through Friday, excluding court holidays. report abuse california. Mental Health Consumer Perception Survey-Fall 2019 New! The departments mission is to work in the partnership to promote and improve health, wellness, safety and quality of life. Job Assistance, Stay informed about SB County eventsand news through ourYouTube Playlist, Sat, December 10, 2022, 10:00 AM - Sun, June 11, 2023, 4:00 PM, Wed, January 18, 6:00 PM - 7:00 PM + 6, Click to see more. 0 0 7.875 8.625 re The San Bernardino County Department of Child Support Services determines paternity, establishes and enforces child support orders, and secures payments to assist the financial and medical needs of their children. San Bernardino Independent: 36: 150 E Holt Blvd, 3rd Floor, Ontario, CA 91762: 909-458-1637: 909-986-2970: San Diego Independent: 37: To see if you will need any special, local forms, contact your court clerk or check your court's website. Application to Determine CCS Program Eligibility (DHCS 4480, 01/22) 21 0 obj <> endobj ENGLISH SPANISH 2. All Forms Assessor Forms Recorder Forms County Clerk Forms All Assessor-Recorder-Clerk Forms Show entries Search: Showing 1 to 10 of 147 entries Previous 0 This site uses cookies to enhance site navigation and personalize your experience. 2rLr2Fz@2"c. The California Public Records Act is found in the California Government Code, beginning at Section 6250. Child Abuse Hotline for San Bernardino County is. Mail the completed SS 8572 form to: Child Abuse Hotline P.O. Child Protective Services. "San Bernardino County [and] CPS are on notice," Carter warned. 1345 0 obj <> endobj 0 0 6.75 7.5 re `AS`8W!L$T1R1!PE b@. T endstream endobj 28 0 obj <>/Subtype/Form/Type/XObject>>stream 2. get answers. endstream endobj 47 0 obj <>/Subtype/Form/Type/XObject>>stream You will need to pay the fee or submit a Request to Waive Court Fees. Our DIRECT LINE: 1-929-277-7848 to begin today your POWER-session 1-on 1 (Ext.806) Help Form (go to sue cps main site) www.SUECPS.weebly.com or fill out right on this informative site.. Lawyers sadly per state,are not caring enough to file.. )Vice Chairman/SupervisorFirst District, Jesse ArmendarezSupervisorSecond District, Goals and Objectives f San Bernardino County APS strives to have all elders and dependent adults live their lives free from the threat or reality of abuse. Child Abuse Reporting Policy: 05/13/2021 CHD0303 Child Abuse Reporting Procedure . Phone : 800.722.3181 %PDF-1.7 % endstream endobj 44 0 obj <>/Subtype/Form/Type/XObject>>stream County Operator General County Information Telephone: Toll Free (888) . Enhances the quality of life in the community by administrating support programs to persons in need of financial, nutritional and/or medical assistance while working with families and individuals to attain self-sufficiency. Thank you for the opportunity to assist you! 0 0 6.75 7.5 re CFS works to prevent further harm to children from physical or mental injury, sexual abuse, exploitation, or neglect. endstream endobj 49 0 obj <>/Subtype/Form/Type/XObject>>stream 2r\.1K 7 endstream endobj 31 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 41 0 obj <>/Subtype/Form/Type/XObject>>stream E-mail: prr@sb-court.org. 0.749023 g 1. Call the child abuse hotline at 909-384-9233 (San Bernardino area) or 1-800-827-8724 (outside of San Bernardino). Call (833) 526-5197 to schedule a consultation to get your immediate questions answered and get the legal representation you need. Serves veterans and their families and ensure they receive the benefits they have earned. when an social worker,caseworker at CPS has clearly undermine her family for 8 years & others. and at-risk adults in our county. 2: Ask what the accusations and charges are. Child and Family Teams (CFTs) During this state of emergency related to the Novel Coronavirus (COVID-19), the CFT process serves as an essential strategy to ensure families and providers can continue caring for children and that the county is aware of the practical and emotional needs of caregivers and children. For Financial Institutions If you are interested in viewing a PowerPoint presentation on financial abuse, please click here: Below are a few helpful hints on how to navigate . Request for Second Opinion QM048_E Revised! font (Spanish), Opioid Agreement for Buprenorphine Medication Assisted Treatment (Spanish), Opioid Agreement for Buprenorphine Medication Assisted Treatment (English), Beneficiary Nondiscrimination Notice (Mandarin), Beneficiary Nondiscrimination Notice (Vietnamese), Your Rights Attachment (NOABD) (Mandarin), Your Rights Attachment (NOABD) (Vietnamese), Change of Provider Request Form 18pt. Report Waste, Fraud & Abuse, County Job Openings Child Abuse Hotline (800) 827-8724 Child Abuse Prevention/Safe Kids (909) 383-9677: Child and Family Health . Please be advised that incomplete or inaccurate information may delay the processing of your request. E\i\\ 0 0 7.125 7.125 re First time applicants can access helpful information on how to get started by clicking "Applicant Information" in the menu drop down. 0.749023 g endstream endobj 34 0 obj <>/Subtype/Form/Type/XObject>>stream The nature of specific incident(s) you are reportingand, Date(s) and descriptions(s) of the injuries or dangers, Identities of perpetrator(s) and their relationship/s to thechild, Witnesses to the incident(s) and how they may be reached, Details of any physical evidence available, The perpetrator'scurrent access to the child, Present condition/status of the child (for example: inneed of medical attention), Statements from the child(ren) when possible, San Bernardino County Children and Family 2023 San Bernardino County | . Our number one priority is the prosecution of those responsible for committing crimes within our communities so that the safety and security of others are protected. Claim Against County of San Bernardino (pdf). Please turn on JavaScript and try again. C For your convenience, virtual interviews are available. 2rLr2Fz@2"c. CFS does not supply these forms. E\\y\FAS\.BB1X!S` 1 I am an older adult and need help taking care of myself. 90&L$S` V: The Hotline is contacted when a member of the community has a concern regarding potential abuse or neglect of a child. Preschool services feeds meals to children. Welcome to San Bernardino County's Career Opportunities page! Children and Family Services (CFS) is a department within San Bernardino County dedicated to protecting and promoting the well-being of abused, neglected or exploited children in our county. A ^ endstream endobj 48 0 obj <>/Subtype/Form/Type/XObject>>stream To file a claim against the County please complete the form below, print, sign and send to the address listed on the form. San Bernardino County size in square miles, Incorporated cities in San Bernardino County, Auditor-Controller/Treasurer/Tax Collector, George Air Force Base: Commemorating Its Legacy 30 Years Later Exhibit. H*2T0T03Tp. 0 0 7.875 7.5 re Get CA CFS 125 CPS - San Bernardino County 2013-2022 Get form. Accessibility To request versions of these forms accessible to persons with visual disabilities, make a note of the form name and click here. endstream endobj 22 0 obj <> endobj 23 0 obj <> endobj 24 0 obj <> endobj 25 0 obj <>/Subtype/Form/Type/XObject>>stream He was beaten and burned while in state custody foster "care". of Industrial Relations web site. 9445 Fairway View Place, Suite 110 Rancho Cucamonga, CA 91730 909-948-6200. 247 West Third Street, 11th Floor. H237402VH2P0P007U332U(JJ*2T0T0\ /"gg$s`*RFpb@. }= The San Bernardino County District Attorney's Office serves the residents, business owners, and visitors of San Bernardino County, California. If you have hardcopy documents you would like to have included in the investigation you may download a printable copy of this online form here, attach those documents and mail or Fax it to us at: 909-252-4359. 0 k Create this form in 5 minutes! Winner of 82 national awards for innovation, efficiency, and public service. Welcome to San Bernardino County America's largest county. The forms may be posted on their site. San Bernardino County - Local Forms Downloading & Viewing Directions Your computer must have the Adobe Acrobat Reader installed in order to view any of these documents.You will need to download Adobe Acrobat Reader from Adobe's website. This year, San Bernardino County settled a lawsuit for $7.5 million in a case that alleged that a county social worker was aware of sexual abuse in the foster care system and failed to report it. Get access to thousands of forms. H*2T0T007U0332U(J ,&?(bYY Vb4*LgPr`2GH X, 9974|3/ Wy8L@O q][Wk9URk#w+mr5A! Resource Parents are often called upon to provide information to the child protective services worker, as well as to testify in court. 0 0 8.898 8.899 re Winner of 82 national awards for innovation, efficiency, and public service. Ergonomic Assessment Level (12/12/2018) New! The Adult Protective Services (APS) program is mandated by the State of California. send to the address listed on the form. H237402VH2P0P Forms & Fees - San Bernardino County Assessor-Recorder-Clerk Forms & Fees Fees for all Assessor services Fees for all Recorder and County Clerk services For the Recorder fee calculator click here. font (English), Code of Professional Conduct for Drug and Alcohol Staff, Adolescent (Age 12-17) and Young Adult ASAM TRIAGE LEVEL OF CARE SCREENING Instructions, Consent for SUD Care Coordination Services (Spanish), Care Coordination Needs Determination Screening Tool (English), SUD Care Coordination Needs Determination Screening Tool (Spanish), Care Coordination Discharge Summary (English), Care Coordination Discharge Summary (Spanish), Privacy and Security Incident Reporting Form, Mental Health Professional Licensing Waiver Request, Notice of Personal Rights / Civil Rights Spanish, Substance Use Disorder and Recovery Services Intake Ass, Adult (Age 21 and Over) DMC-ODS Transition, Handbook Summary and Acknowledgement Form (English), Handbook Summary and Acknowledgement Form (Spanish), SUDRS-MH Grievance and Appeals Process Brochure (English), SUDRS-MH Grievance and Appeals Process Brochure (Spanish), SUDRS-MH Grievance and Appeals Process Brochure- 18pt. APS - Central Intake. Adolescent (Age 12-17) and Young Adult (Age 18-20) DMC-ODS Transition New! If not, the site will list the address and phone number of your local courthouse. The reporter's identity is confidential, but a name should be given so the Department could follow-up contact with the reporter if necessary. Strives to provide services, support, protection and conservatorship to older adults, at-risk individuals and adults with disabilities so they may thrive in their communities. endstream endobj 53 0 obj <>/Subtype/Form/Type/XObject>>stream %PDF-1.6 % Claim Against County of San Bernardino (pdf) County of San Bernardino Employees If you need to file a claim for Workers' Compensation please report to your supervisor for appropriate follow-up and related document completion. Form filing and decrease human errors 9445 Fairway View Place, Suite 110 Rancho,. Wk9Urk # w+mr5A or inaccurate information may delay the processing of your local.... 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Voices Of The Underrepresented