BHS Downloads and Client Informing Materials

All consumer posters and brochures for Medi-Cal clinic sites are downloadable from this page.

Please contact AQIS AOABH at ksabet@ochca.com
or call (714) 834-5601 for any questions.

Patient's rights posters and brochures are in downloadable format at the
Patients' Rights Advocacy Services website.

Visit the
Office of Compliance website or call (714) 568-5614 to ask questions or report a concern.

Clinical Information

Title

Arabic

English

Farsi

Korean

Spanish

Vietnamese

Pediatric Symptom Checklist (County Version)

 

Pediatric Symptom Checklist (Contract Version)

PSC-35 IRIS Entry Quick Guide (Contract Programs)

PSC 35 Interpretation

     Clinical Supervision

AOABH Medication Consents

Psychiatrist Information/Downloads

Click on the icons in the tables below to download the appropriate file.

Medi-Cal Information (For Distribution to Consumers)

Description

Arabic English Farsi Korean Spanish Vietnamese
Advance Health Care Directives (F346-705) PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits Spanish PDF version of Notice of Privacy Practices Employee Benefits Vietnamese PDF version of Notice of Privacy Practices Employee Benefits
Mental Health Plan Intake/ Advisement Checklist
(
F346-753) (October 2017)
PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits
Grievance or Appeal Form
(F346-706) (October 2017)
PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits
Grievance & Appeal Process Posters
(October 2017)
PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits
Medi-Cal Handbook
(October 2017)
PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

Audio Version
NPP Acknowledgement (F042-01.1994) (County Intranet Only) PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits

Involuntary Detention Information 

Notice of Privacy Practices (NPP)

Description Arabic English Farsi Korean Spanish Vietnamese
Notice of Privacy Practices (NPP)
PDF version of Notice of Privacy Practices Employee Benefits
PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits
Spanish PDF version of Notice of Privacy Practices Employee Benefits
Vietnamese PDF version of Notice of Privacy Practices Employee Benefits
This is the County NPP given to patients/clients at the first delivery of medical treatment services. The NPP is also mailed to patients/clients provided medical benefits under an HCA supported health plan such as CCS, MSN, or CTU. Form #F042-01.1996

Notice of Privacy Practices Acknowledgement

Description Arabic English Farsi Korean Spanish Vietnamese
Notice of Privacy Practices Acknowledgement
PDF version of Notice of Privacy Practices Employee Benefits
PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits
Spanish PDF version of Notice of Privacy Practices Employee Benefits
Vietnamese PDF version of Notice of Privacy Practices Employee Benefits
This form helps the Orange County Health Care agency demonstrate that we have given our Notice of Privacy Practices (NPP) to each patient at the first point of service. This form is used to obtain client/patients signed acknowledgement of receipt.
Authorization to Use and Disclose Protected Health Information
(F346-531B)
PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits PDF version of Notice of Privacy Practices Employee Benefits
Revocation of Authorization to Use or Disclose Public Health Information
(form fillable 12/12/14)
PDF version of Notice of Privacy Practices Employee Benefits

 Forms - FOR COUNTY USE ONLY
Description                  Arabic Cambodian Chinese English Farsi Hmong Punjabi Spanish Vietnamese
Car Seat Safety Flyers
(County Use Only)     
 PDF version of Notice of Privacy Practices Employee Benefits        PDF version of Notice of Privacy Practices Employee Benefits     PDF version of Notice of Privacy Practices Employee Benefits
PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits 
 
PDF version of Notice of Privacy Practices Employee Benefits
    PDF version of Notice of Privacy Practices Employee Benefits
PDF version of Notice of Privacy Practices Employee Benefits

PDF version of Notice of Privacy Practices Employee Benefits

Description Chinese English Korean Spanish Vietnamese
National Voter Registration Act (NVRA) Preference Forms
National Voter Registration FAQs
(County Use Only) 

PDF version of Notice of Privacy Practices Employee Benefits
 

PDF version of Notice of Privacy Practices Employee Benefits


PDF version of Notice of Privacy Practices Employee Benefits
 

Spanish PDF version of Notice of Privacy Practices Employee Benefits


Vietnamese PDF version of Notice of Privacy Practices Employee Benefits

Read about downloading files.