1. Sample County and Contract Forms and Resources
Reasons for Recoupment
Included Diagnosis List
NOA-A & Back English Spanish Vietnamese Farsi Korean Arabic
Consumer Rights Poster English Spanish Vietnamese Farsi Korean
JV220 Application (typically for SSA or Probation Staff to complete)
JV220A
JV220B
BHS Medi-Cal Provider Info

2. Sample Contract Forms and Resources Only
Assessment Summary (v7.0)
Six-Month Update or update page (v7.0)
Annual Update (v7.0)
Treatment Plan for Non-Assessment Services (Interim Care Plan - ICP)
Care Plan
MD Med Monitoring Contract (Brief)
MD Med Monitoring Contract (Long)
MD ED/Progress Note Contract
CYBH ED/Progress Note Contract
Contract Psychiatrist Hard Copy
Contract Regional Hard Copy
Contract Rehab Hard Copy
Contract STRTP Hard Copy
Contract TAY Hard Copy

3. Sample Contract Assessments & Care Plan
Regional Contract Sample Assessment & CP
Rehab Contract Sample Assessment & CP
STRTP Contract Sample Assessment & CP
TAY Contract Sample Assessment & CP
Sample Psychological Testing Report
Sample Annual Update & CP
Sample Interim Care Plan (ICP)

4. Sample Progress Notes Contract Progress Notes (Paper)
STRTP Progress Notes
Case Management
Assessment
Individual Therapy
Family Therapy
Group Therapy
Crisis Intervention
Crisis Psychotherapy
Individual Rehab
Family Rehab
IHBS
ICC
Assessment
Individual Therapy
Collateral Therapy
Crisis Psychotherapy
Family/Collateral Rehab
IHBS
ICC Child Family Team Meeting

5. Webpage Links for NPT Revised 2018 Trainings
Slide 20 Reason for Recoupment Link
Slide 23 Included Diagnosis List
Slide 52 (Go to Sample Contract Assessments & Care Plan Above)
Slide 86 (Go to Sample Progress Notes Above)
Slide 114 Group Note
Slide 154 Informed Consent for Treatment
Slide 154 Guide to Medi-Cal Mental Health Services and List of Providers
Slide 154 Notice of Privacy Practices (NPP) – MHP and Provider version
Slide 159 (Go to Sample County and Contract Forms and Resources above)
Slide 160 English Beneficiary Rights Poster
Slide 162 Feb 2016 Info Notice (DHCS)
Slide 162 Updated Pathways to Well-Being (Katie A)/ICC & Intensive Services assessment form Slide 162 Info Notice ICC and IHBS Lockout Removal
Slide 174 CYBH Coding and Documentation Manual
Slide 186 Revocation Form: Revocation of ATD
Slide 186 Instructions: Instructions for Revocation of ATD
Slide 187 ATD Form Slide 187 Instructions and Training Slide 187 Policies and Procedures
Slide Notice of Privacy Practices
Slide Use and Disclosure of PHI – General
Slide Missing/Lost Charts
Slide Transport of Clinical Records

6. Webpage Links for NPT Revised 2018 Trainings Continue
Slide 188 * Tracking Disclosures of PHI *Tracking Disclosure Form
Slide Accounting for Disclosures of PHI
Slide 190 HIPAA P&Ps:
Slide Sanctions for Privacy & Security Violations III-1.05
Slide 200
Slide 201 Voter Registration Info:
Slide 201
Slide 201 NPP
Slide 201 Car Seat Safety Law
Slide 201 Advance Directive (For SUD and Mental Health Programs)
Slide 201 Trafficking & Violence Protection Act
Slide 201 Elder/Dependent Adult Abuse Reporting
Slide 201 Intake Advisement Checklist
Slide 212 County Code of Conduct Ver. 7
Slide 215 BHS P&Ps:
Slide 217 P&P Documentation of Services
Slide 217 P&P Fraud and Abuse
Slide 217 P&P Billing Compliance
Slide 232 NPI Website

7. Webpage Links for NPT Revised 2018 Trainings
Contract Regional
Slide 234 Sample Interim Care Plan (ICP)
Slide 235 Regional Contract Sample Assessment & CP
Slide 236
Slide 236
Slide 237 (Go to Sample Progress Notes – Contract Progress Note – Paper above)
Contract Rehab
Slide 234 Sample Interim Care Plan (ICP)
Slide 235 Rehab Contract Sample Assessment & CP
Slide 237 (Go to Sample Progress Notes – Contract Progress Note – Paper above)
Contract STRTP
Slide 234 Sample Interim Care Plan (ICP)
Slide 235 STRTP Contract Sample Assessment & CP
Slide 238 (Go to Sample Progress Notes – STRTP Progress Notes above)
Contract TAY
Slide 238 Sample Interim Care Plan (ICP)
Slide 238 TAY Contract Sample Assessment & CP
Slide 238 (Go to Sample Progress Notes – Contract Progress Note – Paper above)