Forms & Publications . Please be advised that incomplete or inaccurate information may delay the processing of your request. In alignment with the Countywide Vision to create a county in which those who reside and invest are able to prosper and achieve well-being, Human Services works to build a healthy community by strengthening individuals and families, enhancing quality of life and valuing people. 0.749023 g CFS 125 CPS (1/13) SAN BERNARDINO COUNTY CHILDREN and FAMILY SERVICES REPORT OF MEDICAL / DENTAL EXAM FOR HEALTH PASSPORT UPDATE FAX or RETURN in the POSTPAID ENVELOPE FFA must give original to social worker or PHN PUBLIC HEALTH NURSE . ,&?(bYY Vb4*LgPr`2GH X, 9974|3/ Wy8L@O q][Wk9URk#w+mr5A! Y"]FjsIodfDxtg0*w*iK vx5Y}p xSm >{TfB@o|H5Kaw0d:4{NCNl(~hY)_^.cmY9qjO c Substance Use Disorder and Recovery Services Policy, Substance Use Disorder and Recovery Services Procedure, Naloxone Intranasal Distribution Procedure, Client Tuberculosis (TB) Testing and Services Policy, Client Tuberculosis (TB) Testing and Services Procedure, myAvatar Electronic Health Records Policy, myAvatar User Account Creation and Reinstatement Procedure, myAvatar User Account Modification Procedure, myAvatar User Account Deactivation Procedure, Criteria for Beneficiary Access to SMHS Medical Necessity and other Requirements, No Wrong Door for Mental Health Services Policy, Revised Mental Health Co-Staffing Chart Documentation a, Personal Protective Equipment (PPE) for DBH Programs, Quality Management Chart Documentation Guidance due to, New Classification of Other Qualified Providers, Coronavirus (COVID-19) Information for DBH Workforce, Mental Health Consumer Perception Survey Spring 2019, DMC-ODS UCLA Treatment Perception Survey-October 2019, Notice of Changes to EPSDT Data Collection Requirements, Editing Notice of Adverse Benefit Determination (NOABD). Use professional pre-built templates to fill in and sign documents online faster. 0.749023 g Registration process. California Children's Services Forms. (Courtesy of Eric Bahra) Two children disclosed that the foster father had sexually . endstream endobj 27 0 obj <>/Subtype/Form/Type/XObject>>stream San Bernardino Independent: 36: 150 E Holt Blvd, 3rd Floor, Ontario, CA 91762: 909-458-1637: 909-986-2970: San Diego Independent: 37: endstream endobj 43 0 obj <>/Subtype/Form/Type/XObject>>stream f Complete the CPS Records Request Form below and fill it out with as much information as possible. endstream endobj 34 0 obj <>/Subtype/Form/Type/XObject>>stream 2\`q#=csS&c. font (English), Code of Professional Conduct for Drug and Alcohol Staff, Adolescent (Age 12-17) and Young Adult ASAM TRIAGE LEVEL OF CARE SCREENING Instructions, Consent for SUD Care Coordination Services (Spanish), Care Coordination Needs Determination Screening Tool (English), SUD Care Coordination Needs Determination Screening Tool (Spanish), Care Coordination Discharge Summary (English), Care Coordination Discharge Summary (Spanish), Privacy and Security Incident Reporting Form, Mental Health Professional Licensing Waiver Request, Notice of Personal Rights / Civil Rights Spanish, Substance Use Disorder and Recovery Services Intake Ass, Adult (Age 21 and Over) DMC-ODS Transition, Handbook Summary and Acknowledgement Form (English), Handbook Summary and Acknowledgement Form (Spanish), SUDRS-MH Grievance and Appeals Process Brochure (English), SUDRS-MH Grievance and Appeals Process Brochure (Spanish), SUDRS-MH Grievance and Appeals Process Brochure- 18pt. 0.749023 g County Operator General County Information Telephone: Toll Free (888) . Child Abuse Report. H*2T0T037U03U(J f 9445 Fairway View Place, Suite 110 Rancho Cucamonga, CA 91730 909-948-6200. San Bernardino County 211 get connected. For Financial Institutions If you are interested in viewing a PowerPoint presentation on financial abuse, please click here: SAN BERNARDINO COUNTY CHILD AND FAMILY SERVICES - CHILD PROTECTIVE SERVICES The program provides child protective services for San Bernardino County. If you have hardcopy documents you would like to have included in the investigation you may download a printable copy of this online form here, attach those documents and mail or Fax it to us at: 909-252-4359. E\i\\ Please enable scripts and reload this page. The Court Executive Office's hours are 8:00 a.m. to 5:00 p.m., Monday through Friday, excluding court holidays. The reporter's identity is confidential, but a name should be given so the Department could follow-up contact with the reporter if necessary. Help Count the Unsheltered and Make a Difference. Human Services works to build a healthy community by strengthening individuals and families, enhancing quality of life, and valuing people. Report Waste, Fraud & Abuse, County Job Openings 24 Hour Hotline 1-877-565-2020 : Video Announcements. 0.749023 g San Bernardino County Workforce Development Board, Community Policy Advisory Committee (CPAC), Cultural Competency Advisory Committee (CCAC), Behavioral Health Commission (BHC) Meeting is Going Dark. hb```e``0i% X8 99p0P0]3 D+Zd NU*0C!UC Forms & Fees - San Bernardino County Assessor-Recorder-Clerk Forms & Fees Fees for all Assessor services Fees for all Recorder and County Clerk services For the Recorder fee calculator click here. It looks like your browser does not have JavaScript enabled. To submit a form via email, users must first download the form to their device and then click "submit" on the completed form. `AS`8W!L$T1R1!PE b@. T The appropriate county CWS agency is the county, in which, the child resides. Our number one priority is the prosecution of those responsible for committing crimes within our communities so that the safety and security of others are protected. Substance Use Disorder and Recovery Services, Services Guide, Directories and Resource Library, Children and Youth Collaborative Services (CYCS), Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (Mandarin), Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (Spanish), Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (VIE), Change of Provider Request Form 18pt. He was beaten and burned while in state custody foster "care". You may be trying to access this site from a secured browser on the server. Get the free san bernardino county children and family form cfs 125 cps 2014-2022. . 0.749023 g E\\y\Fz0\.S=3H!C 9 Website Get access to thousands of forms. %%EOF 0 0 8.25 9 re %%EOF Information on how to report child abuse or make complaints. A ^ County Job Descriptions and Salaries Call 877.410.8829 Live agents are available Monday-Friday from 7 a.m. - 5 p.m. Stay informed with new authentication options! Easily fill out PDF blank, edit, and sign them. endstream endobj 51 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 40 0 obj <>/Subtype/Form/Type/XObject>>stream H*2T0T032f@(++5167UKZ y9\PP9#D1W @ ch The Isaac Lethbridge Story: A Two-Year-Old Killed in a Michigan Foster Home in 2006. C State of California's, Department H237402VH2P0P037U03U(JJ*2T0T0BC#S\.1* e can be found on the State of California's, Department San Bernardino County residents can dial. 123 0 obj <>/Filter/FlateDecode/ID[<4E5FEE2E7615B60FE59503200306F587>]/Index[21 218]/Info 20 0 R/Length 225/Prev 152285/Root 22 0 R/Size 239/Type/XRef/W[1 2 1]>>stream CFS values collaboration with community agencies and private citizens to accomplish our mission of protecting children and promoting their well-being. If you are interested becoming a volunteer and working with social workers at CFS, please apply at: http://hss.sbcounty.gov/VIP/default.asp VIP CFS brochure 2019.pdf 90&L$S` V: The California Public Records Act is found in the California Government Code, beginning at Section 6250. 2. Try it now! endstream endobj 47 0 obj <>/Subtype/Form/Type/XObject>>stream This site uses cookies to enhance site navigation and personalize your experience. The legal intervention of child welfare agencies, through the judicial (court) system, to protect children and families. Take a look back at San Bernardino Countys major accomplishments in 2022, Homeless to Home, a road to self-sufficiency. Change of Provider Request Form - 18pt. Information on California Workers' Compensation rights and responsibilities (PC Section 11165.9.) . H*2T0T007U0332U(J font (Spanish), SUDRS-MH Grievance and Appeals Process Brochure-18pt. endstream endobj 38 0 obj <>/Subtype/Form/Type/XObject>>stream 0 K t f e-Prescribing Chart Documentation (12/07/2016) New! The Family Court has extensive jurisdiction over many domestic matters. San Bernardino County is comprised of more than 40 departments and agencies staffed by more than 25,000 public service professionals providing a wide range of vital services in areas that include public safety, health and human services, economic development, housing, recreation, and culture. Samples can be emailed to you by request at: selfhelpforms@sb-court.org. CFS works to prevent further harm to children from physical or mental injury, sexual abuse, exploitation, or neglect. endstream endobj 50 0 obj <>/Subtype/Form/Type/XObject>>stream . 0 909-484-7667. The following are forms for the California Children's Services Program.. However. To file a claim against the County please complete the form below, print, sign and endstream endobj 29 0 obj <>/Subtype/Form/Type/XObject>>stream Health and Human Services Public Safety and Justice Community Services Recreation and Culture Government Services Board of Supervisors Col. Paul Cook (Ret.) `Sp8WrU B Below are a few helpful hints on how to navigate . font (Spanish) 06/28/2022 QM047_S Translation Service Request Form . The Child Protective Services goal is to keep the child in his/her own home when it is safe, and when the child is at risk, to develop an alternate plan as quickly as possible. A hotline for impacted residents is open from Monday through Friday, 8 a.m. to 7 p.m. at (909) 356-2563. To speak to someone about behavioral health services, call 888.743.1478. CFS does not supply these forms. It looks like your browser does not have JavaScript enabled. endstream endobj 41 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 8.25 8.625 re Assistance with Family law, Child support, Landlord/tenant, and more. H237402VH2P0P007 0 0 7.875 7.5 re of Industrial Relations web site. Mental Health and Alcohol and Drug Services Agency Evaluation, Timely Access Notice (NOABD) (Vietnamese), Mental Health Plan (MHP) to Medi-Cal Plan (MCP) Referral Form For Non Open Cases, Financial Liability Notice (NOABD) (Spanish), Financial Liability Notice (NOABD) (Mandarin), Financial Liability Notice (NOABD) (Vietnamese), myAvatar Program Assignment (Mental Health), myAvatar Program Assignment (Mental Health)(Spanish), myAvatar Initial Contact Form (Mental Health, myAvatar Initial Contact Form (Mental Health) (Spanish), Authorization to Release Protected Health Information (PHI), Authorization to Release Protected Health Information (PHI) (Spanish), Authorization to Release Protected Health Information (PHI) (Vietnamese), Code of Conduct and Code of Conduct Acknowledgement, Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices, Certification Review Hearing Waiver of Presence, Outpatient Treatment Reauthorization Request for Adults, List of Disclosures of Protected Health Information (PHI), Consent for Outpatient Treatment (Spanish), Consent for Outpatient Treatment (Vietnamese), Medical Care Authorization for Minor (Spanish), Consent for Sound and/or Photographic Recordings, Consent for Sound and/or Photographic Recordings (Spanish), Consent to Record and/or Photograph and Authorization for Use or Disclosure, Consent to Record and/or Photograph and Authorization for Use or Disclosure (Spanish), Conflict of Interest Disclosure Statement, Access to Medical Records Request (Spanish), Response to Request to Access Medical Records, Response to Request to Access Medical Records (Spanish), Request to Amend Protected Health Information (PHI), Request Request to Amend Protected Health Information (PHI) (Spanish), Response to Request to Amend Protected Health Information (PHI), Response to Request to Amend Protected Health Information (PHI) (Spanish), Internal Tracking of Request to Access Medical Records, Release of Information: Patients Right of Access to His/Her Own Medical Record, Release of Information: Patients Right of Access to His/Her Own Medical Record (Spanish), Advance Health Care Directive (Brochure) (Spanish), Advance Health Care Directive (Brochure) (Vietnamese), Privacy and Security Agreement Confidentiality Statement, Ineligible Persons Policy Acknowledgement and Attestation, Attestation Regarding Completion of Sanction Checks, Electronic Signature Agreement and E-Signature and Provider Signature List, DBH & BBS Complaint Notifications to Clients (8-20), DBH & BBS Complaint Notifications to Clients (8-20) (Spanish), myAvatar Policy/Procedure Acknowledgement Form, Patients Rights Grievance Form (Spanish), Patients Rights Office Grievance Appeal Form, Patients Rights Office Grievance Appeal Form (Spanish), Request for Restriction of Confidential Communication, Request for Restriction of Confidential Communication (Spanish), Response to Request for Restriction of Confidential Information, Response to Request for Restriction of Confidential Information (Spanish), Grievance and Appeal Timely Resolution Notice, Grievance and Appeal Timely Resolution Notice (Spanish), Adult (21+) ASAM Triage Level of Care Screening, Consent for SUD Care Coordination Services (English), Termination of Provider Notice Template_Spanish, Receipt of Grievance Acknowledgement Letter, Receipt of Grievance Acknowledgement Letter (Spanish), Grievance Investigation Supplemental Response Form, Pre-Licensed/Out-of-State Licensed Psychologists Statement of Awareness for Continued Employment, Non-Medication Resource Log and Instructions, Emotional Support Animal Clinical Documentation Policy, DMC-ODS Requirements for period 2022-2026, Documentation Requirements for all SMHS DMC and DMC-ODS Services, Clinical Supervision for Pre-Licensed Psychologists, Request to Change the DBH Websites Policy (BOP3047), Request to Change the DBH Websites Procedure (BOP3047-1), Adult System of Care, Intensive and Aggressive Case Management, and ACSP Coordinated Services, Reporting Dependent Adult/Elder Abuse and Neglect Policy, Reporting Dependent Adult/Elder Abuse Procedure, Adult System of Care Out-of-County Placement Policy, DBH Alcohol and Other Drug (AOD) Programs Counselor Certification Policy, Alcohol and Drug Services Code of Professional Conduct Policy, Medication Policy for Clients Seeking Alcohol and Drug Treatment Services, Alcohol and Drug Services (ADS) Youth Treatment Policy, Alcohol and Drug Services (ADS) Perinatal Treatment Policy, Admission Preference and Interim Services Policy, Admission Preference and Interim Services Procedure, Expenditure of the Substance Abuse Prevention and Treatment Block Grant Policy, Substance Use Disorder Medication Safety and Effectiveness Policy, Substance Use Disorder Service Utilization Policy, Substance Use Disorder and Recovery Services Coordination of Care Policy, Substance Use Disorder and Recovery Services Coordination of Care Procedure, Post Client Satisfaction Survey Procedure, Substance Use Disorder and Recovery Services Residential Prior Authorization Policy, Case Management Services for Child and Adolescent Clients, Providing Services to Foster Care, Adoption Assistance Program (AAP) and Kinship Guardianship Assistance Payment (KinGAP) Children Placed Out-of County Policy, Providing Services to Foster Care Children Placed Out-of-County Procedure, Providing Services to Adoption Assistance Program (AAP) and Kinship Guardianship Assistance Payment (KinGAP) Children Placed Out-of County Procedure, Childrens Fund Immediate Need Voucher Policy, Childrens Fund Immediate Need Voucher Procedure, Consent to Treat a Minor: Procedures for Parents/Legal Guardians, Consent to Treat a Dependent Minor Procedure, Clinic Responsibility for Processing Client Registration, PFI, CDI, Charge Data Invoice (CDI) Process Procedure, Treatment of DBH Employees by DBH Facilities, Acknowledgement of Abuse Reporting Duties Policy, Clinical Supervision for Licensure AMFT, ACSW, APCC, Admission Standards for Penal Code Misdemeanor Violations, Out-of-County Access for Mental Health Services, Waiver of Consumers Responsibility to Pay for Medications, Authorization and Designation Pursuant to the Lanterman-Petris-Short (LPS) Act, Duty to Warn and Protect Third Parties in, Duty to Warn and Protect Third Parties in Response to a Client Threat (Tarasoff) Procedure, Day Treatment Weekly Charting in Staff Meetings, Confidentiality When Dealing with Client Support Persons, Clients with Physical Medical Conditions Policy, Transformational Collaborative Outcomes Management (TCOM) Policy, Transformational Collaborative Outcomes Management (TCOM) Procedure, Client Notice Regarding Termination of Provider Procedure, Sending Confidential Information by Facsimile, Medical Record Security Policy for Outpatient Services, Confidentiality of Protected Health Information (PHI), Unauthorized Access of Confidential Medical Records, Medical Records Requiring Special Handling, Medical Records Requiring Special Handling Procedure, HIPAA Notice of Privacy Practices (NOPP) Policy, Authorization to Release Protected Health Information (PHI) Procedure, Trafficking Victims Protection Act of 2000, Compliance Verification, Monitoring and Auditing Policy, Security of Protected Electronic Health Information Policy, Access and Amendment of Medical Records Policy, Patients Rights Inpatient Grievance Process, Patients Rights Outpatient Grievance Process, HIPAA National Provider Identifier (NPI) Policy, HIPAA National Provider Identifier (NPI) Procedure, Right to Request Alternative Means of Communication Protected Health Information Policy, Medi-Cal Eligibility Data Systems (MEDS) Policy, Transportation of Protected Health Information (PHI) Policy, Transportation of Protected Health Information (PHI) Procedure, Non-Discrimination of Clients (Affordable Care Act) Policy (COM0953) Rev. 0 0 7.875 7.5 re of Industrial Relations web site Relations web site personalize your experience helpful. 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