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Mental Health Information - Providers

The official Mendocino County website has a new home! Please visit:
MendocinoCounty.org

The content here is no longer updated and will soon redirect to the new site.

24/7 Toll Free Crisis Line

If you are in crisis and need help right away, call:
1-855-838-0404

Mendocino County Mental Health Plan (MHP) offers free Language Line Interpreter assistance and TTY/TDD services for beneficiaries requesting or accessing services. These services may be requested at any Mental Health Plan Provider site or by calling the Mendocino County Access Line: 1-800-555-5906

Linea de Crisis Llamada Gratis 24/7

Si esta una crisis y necesita ayuda imediamente:
1-855-838-0404

Plan de Salud Mental del Condado de Mendocino (MHP) ofrece servicios de asistencia gratuita con traductor de idiomas en lina TTY/TDD para los beneficiarios que lo requieran / o tengan accesso a los servicios. Estos servicios pueden ser requeridos con cualquier proveeder del Plan de Salud Mental o llamondo al 1-800-555-5906



English Spanish
Forms
Diagnosis/Periodic Update
UMDAPUMDAP
What is UMDAP? (Information Sheet) ¿Qué es el UMDAP? (Information Sheet)
Closing Summary
Application for Services & Consent to Treatment / HIPAA Notice of Privacy Practices & Other Information Receipt Aplicación por Servicos y Consentimiento Para Tratamiento / Notificacion de Prácticas Confidenciales y Otra Informacion el Recibo
Release of Confidential Information Forms (ROI)
CCC Multi Agency Release of Information (ROI)
Multi Agency Release of Information (ROI)
Release of Information - Second Party (ROI) La Autorizacion Para Divulgar o Recibir Informacion Confidencial
AB109 Release of Information (ROI)
Therapeutic Behavioral Services (TBS)
TBS Request for Authorization
Acknowledgment of TBS-EPSDT Notification Recibo Por Servicios Tempapeuticos de Conducta (TBS/EPSDT)
TBS Assessment and Plan
TBS Monthly Review & Transition Plan
Early & Periodic Screening, Diagnosis & Treatment (EPSDT) Brochure Detección, Diagnostico y Tratamiento Oportunos y Periódicos (EPSDT) el Folleto
General Policy and Procedures
Philosophical Principles - Goals of Mendocino County Mental Health Program
Department Philosophy Regarding Medication
Cultural Competence Role of Cultural Competency Committee
Mental Health Plan Hours of Operation
Administration Policies
- Under Revision
Treatment Services
Point of Authorization Policy and Procedure, Excluding DDS Katie A./WRAP

CANS Youth User Guide
Staffing Verification Privileges for Clinicians, Mental Health Rehab Specialists and Care Managers

© Copyright 1997-2017, The County of Mendocino
501 Low Gap Road, Ukiah, CA 95482