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

Outcome Measure Workflows new

CYPBH Medication Consents (F346-7921)

Psychiatrist Information/Downloads

                (Effective 1/1/2018)

Medi-Cal Information (For Distribution to Consumers)

EPSDT-TBS Brochures (MC-003-DHCS)

Advance Health Care Directives (F346-705)

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

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

Grievance & Appeal Process Posters (October 2017)

Medi-Cal Handbook

HIPAA

Involuntary Detention Information 

NPP Acknowledgement
(F042-01.1994) County Intranet Only

Authorization to Use and Disclose Protected Health Information (F346-531B)

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

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