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Last Updated:  06/23/2005

Copyright © 2005
Alameda County Behavioral Health Care Services

The following files are in Microsoft Word template format.  Please download the file and save on it on your local computer for future use.

AB 3632

• Discontinue Service
• Service Notification
• Utilization Form

Assessment Center

• Intake
• Birth to 5 years old
• Ages 6 and older

Authorization and CQRT

• 0-5 Early Childhood Day Treatment Authorization
• Clinical/Quality Review (rev. 5/04)
• Client Registration
• Consumer Complaint Problem Resolution/Grievance Information
• Day Treatment Authorization Criteria
• Placement Authorization (rev. 4/05) (Instructions)
• RCL 13/14 Survey for Certification of Child

Initial Assessment

• Youth
• Medication Support

Progress Notes

• Case Management
• Day Intensive
• Day Rehab Weekly
• Guidance Clinic
• Medication Support
• Mental Health Services

Treatment Plan

• Youth
• Medication Support

Other

• Community Functioning Evaluation (CFE)
• Discharge Summary
• Mandatory Abuse Report Form