Other Documents
- Lock Box Release from Liability
- Owner Responsibilities of a Service-Assistive Animal
- Patient Health Questionnaire 9 (English)
- Patient Health Questionnaire 9 (Spanish) for the USA
- Child Youth Health Questionnaire Age 0-17
- Adult Health & Nutrition Questionnaire Age 18+
- Patient Telehealth Instructions
- Patient Telehealth Instructions (Spanish)
- Letter of Assurance (English)
- Medi-Cal Eligibility Guide
To Review for Intake Session
- 01 Informed Consent
- 01S Informed Consent – Spanish
- 02 Consent to Treat Minor Children
- 02S Consent to Treat Minor Children – Spanish
- 03 Acknowledgement of Receipt
- 03S Acknowledgement of Receipt – Spanish
- 04 Financial Information Form Cover Letter
- 05 Financial Information Form
- 05A UMDAP Worksheet Juvenile Justice Diversion & Treatment Program (JJDTP)
- 05B UMDAP Fee Waiver Request JJDTP
- 06 Request to Communicate Electronically
- 06S Request to Communicate Electronically – Spanish
- 07 Mental Health Service Expectations
- 07S Mental Health Service Expectations – Spanish
- 08 FIT On-Call System Flier
- 08S FIT On-Call System Flier – Spanish
- 09 River Oak On Call System Intensive Community Based Services
- 10 Authorization to Release and Exchange Private Health Information
- 10S Authorization to Release and Exchange Private Health Information – Spanish
- 11 River Oak Consent for Telehealth
- 11S River Oak Consent for Telehealth – Spanish
- 12 Guidelines for Use of Video Conferencing
- 12S Guidelines for Use of Video Conferencing – Spanish
- 13 Pediatric Symptom Checklist (PSC-35)
- 13S Pediatric Symptom Checklist (PSC-35) – Spanish
- 14 Pediatric Symptom Checklist (PSC-35) Youth
- 14s Pediatric Symptom Checklist (PSC-35) – Spanish
For Families to Keep:
- 01 Emergency Card For Your Use
- 02 Explanation of Transportation Benefits and Medi-Cal Behavioral Health Quick Guide
- 02A MediCal Behavioral Health Quick Guide
- 03A River Oak Notice of Privacy Practices
- 03AS River Oak Notice of Privacy Practices – Spanish
- 03B Guide to MediCal Mental Health Services
- 03BS Guide to MediCal Mental Health Services – Spanish
- 03C Advance Medical Directive Brochure
- 03CS Advance Medical Directive Brochure – Spanish
- 03D Medi-Cal Provider List
- 03DS Medi-Cal Provider List – Spanish
- 03E California Voter Registration Online Link
- 04 NIMH Answers Questions about Suicide
- 04S NIMH Answers Questions about Suicide – Spanish
- 05 River Oak Family and Youth Advocate Brochure
- 05 Sacramento County Member Rights & Problem Resolution Guide
- 05S Sacramento County Member Rights & Problem Resolution Guide – Spanish
- 06 River Oak Infection Control Brochure
- 06 Sacramento County Grievance Form
- 06S Sacramento County Grievance Form – Spanish
- 07 Birth and Beyond Brochure
- 07 How to Report a Complaint
- 07S How to Report a Complaint Spanish
- 08 River Oak Infection Control Pamphlet
- 08 Infection Control 2020
- 08 Protect Yourself and Your Family From COVID-19