File a USDA program discrimination complaint? 1. Request for Second Opinion (Spanish) QM048_S Revised! Please turn on JavaScript and try again. Address 150 S. Lena Rd. endstream endobj 41 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 26 0 obj <>/Subtype/Form/Type/XObject>>stream Get e-mail updates on the latest COVID-19 news. Serves veterans and their families and ensure they receive the benefits they have earned. COVID-19: COURT OPERATIONS DURING THE COVID-19 PANDEMICRevised 5/2/2022 - 9:32 am. Fraud, Waste, and Abuse Hotline 800.547.9540. 238 0 obj <>stream Request for Second Opinion QM048_E Revised! Information on California Workers' Compensation rights and responsibilities Step 1: Apply online through the County's Portal, and submit the $667 initial application fee. *{Dt8P *7,Jccd0%m3lz%tDE}vdYiBiplo+4 If you do not see the form you need, please check if it can be ordered through the Children's Medical Services Catalog or contact us and we will try to accommodate your request.. endstream endobj 32 0 obj <>/Subtype/Form/Type/XObject>>stream California Family and Domestic Violence Referral Directory. 0 0 6.75 7.5 re Use Arrears calculator to figure out balance. 1425 South "D" Street San Bernardino, CA 92408 (909) 388-5823 (909) 388-5825 FAX MapQuest EMS CREDENTIALING (909) 388-5819 icemacredentialing@cao.sbcounty.gov 7:30 am to 4:00 pm* Help Desk Support Who live or work in San Bernardino County, Through San Bernardino County Homeless Veterans Initiative. H*2T0T03Tp. Within the State of California you may call toll free 1 (800) 344-6000. endstream endobj 55 0 obj <>/Subtype/Form/Type/XObject>>stream Child Abuse Hotline for San Bernardino County is 1 (800) 827-8724 Child Protective Services (CPS) Hotlines: CPS Hotlines for all 58 counties in California. Complete CA CFS 125 CPS - San Bernardino County 2013-2022 online with US Legal Forms. f It is designed to resolve disagreements arising from divorce and legal separation, including provisions for the care of children. Our DIRECT LINE: 1-929-277-7848 to begin today your POWER-session 1-on 1 (Ext.806) Help Form (go to sue cps main site) www.SUECPS.weebly.com or fill out right on this informative site.. Lawyers sadly per state,are not caring enough to file.. 0 0 7.125 7.125 re endstream endobj 44 0 obj <>/Subtype/Form/Type/XObject>>stream Forms & Publications . H*2T0T0342E\\y\FPn.6RBVT+ provides an avenue for reporting fraud, waste, and abuse within SSA's programs and operations. 0 `$ San Bernardino, CA 92415-0640 (909)891-9019 . endstream endobj 29 0 obj <>/Subtype/Form/Type/XObject>>stream DV, child abuse, sex offender classes Youth Hope, Inc. 255 N. "D" St, Suite 302 San Bernardino 92401 (909)567-2808 Family Service Agency 1661 North "E" Street San Bernardino 92405 (909) 886-6737 Adult classes now offered $20 per class *Contact if Bilingual Services needed Precious Life CES 445 S. Arrowhead Ave Ste. H*2T0T032U0W(J Box 1359 Susanville, CA 96130-1359 Website Los Angeles County Department of Children & Family Services Try it today! endstream endobj startxref It looks like your browser does not have JavaScript enabled. E-mail: prr@sb-court.org. If you are interested becoming a volunteer and working with social workers at CFS, please apply at: http://hss.sbcounty.gov/VIP/default.asp VIP CFS brochure 2019.pdf H237402VH2P0P007U332U(JJ*2T0T0\ /"gg$s`*RFpb@. }= Please turn on JavaScript and try again. Get access to thousands of forms. font (Spanish), SUDRS-MH Grievance and Appeals Process Brochure-18pt. 2: Ask what the accusations and charges are. Contact Us Visit Website View Profile. `Sp8WrU B Covering 20,105 square miles, San Bernardino County is Americas largest county and a diverse public service organization governed by an elected Board of Supervisors and serving a community of nearly 2.2 million residents. If you suspect that a child has been, or is in danger of, abuse or neglect , contact the county Children's Protective Services 24-hour emergency response phone. Show details. Services. 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. Mental Health Consumer Perception Survey-Fall 2019 New! A hotline for impacted residents is open from Monday through Friday, 8 a.m. to 7 p.m. at (909) 356-2563. Please enable scripts and reload this page. 0 0 8.25 9 re First 5 San Bernardino (909) 387-7706 Fishing (909) 38-PARKS: Fleet Management (909) 387-7870: Flies . 0.749023 g ,&?(bYY Vb4*LgPr`2GH X, 9974|3/ Wy8L@O q][Wk9URk#w+mr5A! Call the child abuse hotline at 909-384-9233 (San Bernardino area) or 1-800-827-8724 (outside of San Bernardino). New Medicare Beneficiary Identifier (MBI) New! Accessibility To request versions of these forms accessible to persons with visual disabilities, make a note of the form name and click here. f The California Public Records Act is found in the California Government Code, beginning at Section 6250. San Bernardino County Child & Family Services Administration see details for office hours 150 S Lena Rd San Bernardino, CA - 92415 Phone: (909) 388-0242 Office Details TAD San Bernardino DPSS Office see details for office hours 2050 N. Massachusetts San Bernardino, CA - 92415 Phone: (877) 410-8829 Fax: (909) 475-2231 Office Details Box 1409 San Bernardino, CA 92408. You may be trying to access this site from a secured browser on the server. Adolescent (Age 12-17) and Young Adult (Age 18-20) DMC-ODS Transition New! Phone : 800.722.3181 2018 Superior Court of California, County of San Bernardino, All Rights Reserved |, COVID-19: COURT OPERATIONS DURING THE COVID-19 PANDEMIC, Family Court Services Orientation Class Info, Failure to Appear/Respond to a Jury Summons, Court Case Information and Document Sales, How to Navigate San Bernardino Superior Court, San Bernardino Superior Court Rules of Practice, Local Emergency Rules Related to COVID-19, Online Form Preparation and Filing (TurboCourt), Online Form Preparation and eFiling (TurboCourt), Stipulation For Settlement (CCP 664.6) (fillable), Proof of Service Notice of Appeal (Code Enforcement), Appeal Procedures for Unlimited Civil Cases (Information on), Declaration of Petitioner and Request for Records Check, General Civil Case At-Issue Memorandum (fillable), Declaration and Order Re: Satisfaction of Judgment, CONFIDENTIAL Referral for CII/Carpos/ICMS Report (Civil) - Form A, Order Request for Review of Denial of Request to Remove Name from Gang Database, Initial Trial Setting Conference Statement, Application for Diversion of Individual with Mental Disorder, Order on Application for Diversion of Individual with Mental Disorder, Declaration and Order for Release of Exhibits, Consent to Bring Prohibited Items into the Courthouse as Exhibits (fillable), Stipulation And Order On Request For Order, Referral for CII/CARPOS/ICMS Report (fillable), Family Law At-Issue Memorandum for Trial Setting, Declaration And Order For Issuance Of Writ Of Execution/Abstract Of Judgment (fillable), Order On Petition For Grandparent Visitation, Response To Petition For Grandparent Visitation, Declaration Re: Compliance with Custody Orders (fillable), Petition for Declaring Child(ren) Free from Parental Custody and Control, Citation - Freedom from Parental Custody and Control, Order Declaring Child(ren) Free from Parental Custody and Control, Order on Petition to Terminate Parental Rights of Alleged Father, Petition to Terminate Parental Rights of Alleged Father, Declaration and Order Dispensing with Notice to Alleged Father, Petition to Obtain Original Unsealed/Un-Redacted Birth Certificate, Order on Petition to Obtain Original Unsealed/Un-Redacted Birth, Order on Petition for Birth Record Information, Application to Obtain Final Adoption Order and Order, Application to Obtain Copies from Adoption Case and Order, Petition for Adoption of Adult or Married Minor, Agreement of Adoption of Adult or Married Minor, Consent of Spouse of Adult or Married Minor to be Adopted, Stipulation for Entry of Judgment Re: Establishment of Parental Relationship, Order for Publication of Citation (Adoption), Application for Order for Publication of Citation (Adoption), Notice of Continuance of Hearing (Family Law), Declaration Regarding Objection to Agreement, Family Law/Child Support Copy Request Form, Affidavit/Certificate/Declaration Re: Military Service in an Adoption and Related Matters, Order for Publication of Summons or Citation, Application for Publication of Summons or Citation, Request for Dismissal -- Small Claims Cases, Declaration of Mailing or Inability to Ascertain Address (fillable), Request to Excuse Notice with Due Diligence Declaration, Audio CD Information Sheet and Order Form, Petition for Release of Jury Records and Order, Objection/Response to Packet (Delinquency), Objection/Response to Packet (Dependency), Certification of Competency (Delinquency), Response to Petition for Resentencing (Juvenile), Proof of Service - Juvenile Restraining Order, Ex Parte Application And Order To Serve Summons By Posting, Application for Judgment for Restitution of Premises Only (CCP1169) (fillable), Pretrial Orders Judgment By Court Unlawful Detainer (fillable), To Set Case for Trial - Unlawful Detainer, Application for Issuance of Writ of Execution Per CCP 712.010, Small Claims/Landlord Tenant Copy Request Form, Order Appointing Counsel For Conservatee, Probate Code Sections 1470, 1471, and 2356.5(f)(1), Petition for Visitation (Guardianship Cases Only), Order on Petition for Visitation (Guardianship Cases Only), Order Appointing Counsel For Minor, Probate Code Sections 1470 and 1516.5 (fillable), Notification of Court of Conservatorship Address, Confidential Guardianship Questionnaire and Authorization for Release of Information, List of Required Contact Information for Conservatorships, Optional Attachment to List of Required Contact Information for Conservatorships, Confidential General Care Plan of Conservatee, Ex Parte Petition to Dispense with Accounting and Order (fillable), Request for Deferment of Court Investigator Fee and Order, Affidavit to Comply with California Probate Code 13100-13115, Termination of Guardianship - Parent Questionnaire, Notification of Disqualification from Voting, Notice of Commencement of Proceedings for a Court Supervised Trust, Confidential Information Sheet - Conservatorship, Confidential Information Sheet - Guardianship, Confidential Information Sheet - Intestate Probate, Confidential Information Sheet - Testate Probate, Confidential Information Sheet - Trust Matters, Request for Consideration of Ability to Pay, Waiver of Arraignment & Court Trial Setting. 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cps form san bernardino county