Mental Health Quality Assurance

Under the Quality Improvement Department, the MH Quality Assurance Program oversees program compliance to all local, state, and federal guidelines for quality of care, certification, and utilization management.

MH Quality Assurance Program Contact Information

• Phone: 1 (408) 793-5894
• Email: [email protected]

NOTE: The files below will only open with INTERNET EXPLORER. If you have Windows 10, you may need to use the "PRINT ONLY version".

Practice Guidelines Manual:

• BHSD Practice Guidelines Manual (rev. 3/7/2022)
• History of updates
• September 17, 2020 Memo: 2020 ICD-10 Included Diagnosis

Contract Only Forms:

• Client Open/Change Form - Contractor (PRINT ONLY version )

• Client Discharge Form - Contractor (PRINT ONLY version )

• SRD for MD Use - Rev 11.23.15

Assessment Forms:

• AFI new Toddler Preschool Sept 2015 (Revised w ICD-10)

• AFI new Infant Toddler Sept 2015 (Revised w ICD-10)

• Initial MH Assessment 10.2015

• MH Update Assessment Sept 2015

• Clinical Update for Assessment Form, Rev. 09/21/2016

Attachments:

• FY09-10 Clinical Records Review-Annual Report

• FY07-08 Clinical Records Review-Annual Report

• FY11-12 Clinical Records Review Annual Report

• FY10-11 Clinical Records Review Annual Report

• Quality Improvement Materials Order Form

• SRD For Non-MD Use (ICD-10)_11.23.15, 35(a) Fillable.pdf

• SRD For MD Use (ICD-10)_11.23.15, 36 (a) Fillable.pdf

• R69 Memo 09172020

Grievance & Appeal Forms:

• English, Rev 1/3/19 // Chinese, Rev. 12/2018 // Farsi, Rev. 12/2018 // Spanish, Rev 1/23/19 // Tagalog, Rev. 12/2018 // Vietnamese, Rev. 11/29/18

Patient's Rights Handbook Rev. 05/2014:

• English // Arabic // Cantonese // Farsi // Korean // Russian // Spanish // Tagalog // Vietnamese

Patient's Rights Poster:

•  English // Cambodian // Chinese // Russian // Spanish // Tagalog // Vietnamese

Problem Resolution Process Posters Rev. 07/17/2019:

• English // Chinese // Farsi // Spanish // Tagalog // Vietnamese 

SCC MHD and SUTS Provider Directory Rev. 2/2023: 

• SCC Mental Health Provider List: English // English (Large font) // Chinese // Spanish // Tagalog // Vietnamese // Farsi

• SUTS Provider Directory: English // English (Large font) // Chinese // Spanish // Tagalog // Vietnamese // Farsi

Treatment Plan Forms:

• Transformational Care Planning (TCP) Treatment Plan Interim Update Form

• Psychiatric Assessment 10/07/2015

• Transformational Care Planning (TCP) Treatment Plan Form