AQIS-CYPBH Downloads

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

Please contact AQIS CYPBH at cysqrt@ochca.com or call (714) 796-0123 for any questions.

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

Please contact Patients Rights Advocacy Services at (714) 834-5647 for any additional questions.

Clinical Information

    Caregiver Intake Questionnaires  new 8/7/19 

    Clinical Resources

     Clinical Supervision

 Medication Consents [F346-7921] - 2019

    Outcome Measure Workflows updated01/13/2020

    Pediatric Symptom Checklist new 10/2018 

    Psychiatrist Information/Downloads

Continuity of Care  

Medi-Cal Information (For Distribution to Consumers)

Advance Health Care Directives (F346-705)

Authorization to Use or Disclose Protected Health Information (PHI) 

Please Clink links below to access the most up-to-date Authorization to Use or Disclose (ATD) PHI forms

    EPSDT-TBS Brochures (MC-003-DHCS)

   Grievance or Appeal Form (F346-706)  (October 2017)

    Grievance or Appeal Process Posters (October 2017)

    HIPAA

Involuntary Detention Information 

Medi-Cal Handbook

    Mental Health Plan Intake/Advisement Checklist (F346-753) (October 2017)

Forms - FOR COUNTY OPERATED PROVIDER USE ONLY

Car Seat Safety Flyers (County Use Only)   

Description Chinese English Korean Spanish Vietnamese

National Voter Registration Act (NVRA) Preference Forms
National Voter Registration FAQs
(County Operated Provider 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

Notice of Privacy Practices (NPP)

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 (County Operated Provider Use Only) 

Notice of Privacy Practices Acknowledgement

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. (County Operated Provider Use Only) 

Read about downloading files.