Service Recipient/Beneficiary Forms and Informing Materials

  1. 30-Day Notice of Beneficiary Handbook Change (ENGLISH)2023
  2. 30-Day Notice of Beneficiary Handbook Change (SPANISH).2.23.23
  3. Appeal of Benefit Determination Form (ENGLISH)
  4. Appeal of Benefit Determination Form (SPANISH)
  5. BBS Notice on Filing a Grievance (for Psychotherapy Clients). 2022- SPANISH
  6. BBS Notice on Filing a Grievance (for Psychotherapy Clients)-ENGLISH. 2022
  7. Beneficiary Handbook 2023 (ENGLISH)
  8. Beneficiary Handbook 2023 (SPANISH)
  9. Beneficiary Handbook Availability Notice (ENGLISH)
  10. Beneficiary Handbook Availability Notice (Spanish)
  11. BOP Notice on Filing a Grievance (for Psychotherapy Clients) 2022 (English)
  12. BOP Notice on Filing a Grievance (for Psychotherapy Clients) 2022 (Spanish)
  13. CalAIM-Beneficiary Communication-Materials-7.6.22 (SPANISH)
  14. CalAIM-Beneficiary Communication-Materials-7-15-22 (ENGLISH)
  15. Compliance Hotline Notice (ENGLISH)
  16. Compliance Hotline Notice (SPANISH)
  17. Continuity of Care Request (ENGLISH)
  18. Continuity of Care Request (SPANISH
  19. Grievance Appeal Change Provider Second Opinion-Rights Notice (ENGLISH)
  20. Grievance Appeal Change Provider Second Opinion-Rights Notice (SPANISH)
  21. Grievance Form (ENGLISH)
  22. Grievance Form (SPANISH)
  23. Language_Assistance_Taglines_Final
  24. Napa County MHP Provider Directory_March_2023_English
  25. Napa County MHP Provider Directory_March_2023_Spanish
  26. Non-Discrimination_Notice - 2023 (ENGLISH)
  27. Non-Discrimination_Notice - 2023 (SPANISH)
  28. Notice of Privacy Practices (ENGLISH)
  29. Notice of Privacy Practices (SPANISH)
  30. Notice of Privacy Practices-Summary (ENGLISH)
  31. Notice of Privacy Practices-Summary (SPANISH)
  32. Request to Change Provider (ENGLISH)
  33. Request to Change Provider (SPANISH)