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 new

    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 and Disclose Protected Health Information (F346-531B)

    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)

    NPP Acknowledgement (F042-01.1994) County Intranet Only

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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