If you are interested in becoming a contracted mental health services provider, please reach out to BHRSQM@marincounty.org. If there is anything not listed below that you would find helpful in your efforts to offer the best services possible to clients, please email your contract manager - this can be found on your contract agreement with the County.
Mental Health Contractor Manual Appendices
A collection of documents available to BHRS Mental Health Contract Agency Partners.
- Advance Healthcare Directive.pdf 75.77 KB
- Advance Healthcare Directive (Español).pdf 75.82 KB
- Advance Directives Client Rights.pdf 181.39 KB
- Advance Directives Client Rights (Español).pdf 293.73 KB
- BHRS Reauthorization Request Form.pdf 61.63 KB
- BHRS Standards for Clinical Records.pdf 17.51 KB
- BHRS Utilization Review Guidelines.pdf 116.88 KB
- Change of Provider Request Form - English.pdf 191.29 KB
- Change of Provider Request - English Large Font.pd... 190.01 KB
- Change of Provider Request - Spanish.pdf 126.52 KB
- Change of Provider Request - Spanish Large Font.pd... 125.04 KB
- Change of Provider Request - Vietnamese.pdf 142.69 KB
- Change of Provider Request - Vietnamese Large Font... 157.13 KB
- Client Profile.pdf 343.32 KB
- Perfil Del Cliente (Client Profile_Spanish).pdf 419.52 KB
- CMS 1500 Form Blank.pdf 3.03 MB
- CMS 1500 Form Sample.pdf 1.95 MB
- Consent to Treatment Form 614 (4-2017)- English.pd... 162.01 KB
- Consent to Treatment Form 614S (4-2017)- Spanish.p... 87.3 KB
- Consent to Treatment Form 614V (4-2017)- Vietnames... 193.32 KB
- Cultural Humility Training Tracking Form.xlsx 32.12 KB
- DHCS Provider Certification and Re-Certification P... 833.56 KB
- Diagnosis Update Form.pdf 330.83 KB
- Discharge Form.pdf 269.38 KB
- Grievance Appeal Poster (English).pdf 256.2 KB
- Grievance Appeal Poster (Español).pdf 81.16 KB
- Grievance Appeal Poster (Vietnamese).pdf 160.93 KB
- Grievance Brochure - English.pdf 178.46 KB
- Grievance Brochure - English Large Print.pdf 227.86 KB
- Grievance Brochure - Spanish.pdf 246.92 KB
- Grievance Brochure - Spanish Large Print.pdf 245.43 KB
- Grievance Brochure - Vietnamese.pdf 448.58 KB
- Grievance Brochure - Vietnamese Large Print.pdf 395.28 KB
- Notice of Privacy Practices.pdf 149.91 KB
- HHS Privacy and Confidentiality.pdf 308.49 KB
- Notice of Privacy Practice Acknowledgement - Engli... 104.61 KB
- Notice of Privacy Practice Acknowledgement Spanish... 251.36 KB
- Notice of Privacy Practice Acknowledgement - Vietn... 118.04 KB
- Language Assistance.pdf 618.68 KB