24/7 Toll Free Crisis Line

If you are experiencing a mental health crisis and need help right away, call:

1-855-838-0404

(A danger to oneself or others)

Mendocino County Mental Health Plan (MHP) offers free Language Line, interpreter assistance, American Sign Language, 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 usted esta experimentando una crisis de salud mental y necesita ayuda inmediata, llame:

1-855-838-0404

(Un peligro para uno mismo u otros)

El Plan de Salud Mental del Condado de Mendocino(MHP) ofrece una linea gratis de Idiomas, asistencia de interpretes, Lenguage de Signos Americano, y servicios para personas sordas, servicios para beneficiarios que requieran o tengan acceso a los servicios. Estos servicios pueden ser requeridos con cualquier proveeder del Plan de Salud Mental o llamondo al 1-800-555-5906.

Mental Health Information for Providers

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Forms

English	Spanish
Diagnosis/Periodic Update
UMDAP	UMDAP
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)

English	Spanish
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)

English	Spanish
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

Administration Policies

Under Revision

Treatment Services

Quality Assurance and Performance Improvement

Request Change of Provider

Netsmart MyAvatar FHIR API Information

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