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Behavioral Health Plan and Provider Information

Medi-Cal Behavioral Health Plan - Provider Directory Website

MC BHP Handbook and Provider Directory Lobby Notice

Behavioral Health Plan Member Handbook

cover-medi-handbook

This guide will help you know what specialty mental health services are, if you may get them, and how you can get help from the Orange County MHP.

For general information and accessibility issues please call:

Orange County Behavioral Health Plan
Phone: 800-723-8641
For TTY/TDD users, call 711

 

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This guide is available for listening in MP3 audio format in multiple languages.
About listening to files

Handbook Audio Recording

English 2025

new

Arabic 2024

 

Chinese (Simplified) 2025

new

Farsi 2025

new

Korean 2025

new

 

Russian 2025

new

Spanish 2025

new

Vietnamese 2025

new

 

 

 

BH Provider Handbook Coding Manual 

Behavioral Health Provider Handbook Coding Manual Version 11 (November 2020)
(121 page pdf file)

 

Forms / Brochures

 

TitleArabicChineseEnglishFarsiKoreanSpanishVietnamese
Advance Health Care Directives (F346-705)Acrobat Reader Icon Adobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat Icon
Grievance or Appeal Form (F346-706)
Grievance Tracking Form		Grievance or Appeal Form (Arabic)Grievance or Appeal Form (Chinese)Grievance or Appeal Form (English)Grievance or Appeal Form (Farsi)Grievance or Appeal Form (Korean)Grievance or Appeal Form (Spanish)Grievance or Appeal Form (Vietnamese)
Grievance & Appeal Process Posters *** UPDATED ***Grievance and Appeal Process Posters (Arabic)Grievance and Appeal Process Posters (Chinese)Grievance and Appeal Process Posters (English)Grievance and Appeal Process Posters (Farsi)Grievance and Appeal Process Posters (Korean)Grievance and Appeal Process Posters (Spanish)Grievance and Appeal Process Posters (Vietnamese)
Grievance Fact Sheet MHPGrievance and Appeal Process Posters (Arabic)Grievance and Appeal Process Posters (Chinese)Grievance and Appeal Process Posters (English)Grievance and Appeal Process Posters (Farsi)Grievance and Appeal Process Posters (Korean)Grievance and Appeal Process Posters (Spanish)Grievance and Appeal Process Posters (Vietnamese)
Authorization to Use and Disclose Protected Health Information (F346-531B)Adobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat Icon
Consent to Record (F346-474)  Adobe Acrobat Icon Adobe Acrobat IconAdobe Acrobat IconAdobe Acrobat Icon
Mental Health Plan Intake/Advisement Checklist (F346-753)Adobe Acrobat Icon Adobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat Icon
Psychiatric Medication Consent (F346-7921)Psychotropic Medication Consent (English)Psychotropic Medication Consent (Chinese)Psychotropic Medication Consent (English)Psychotropic Medication Consent (English)Psychotropic Medication Consent (English)Psychotropic Medication Consent (Spanish)Psychotropic Medication Consent (English)
Informed Consent for Services - General (F346-301)Informed Consent Informed Consent Informed ConsentInformed Consent Informed Consent Informed Consent
Informed Consent for Telehealth and Telephonic ServicesInformed Consent - TelehealthInformed Consent - Telehealth 
Informed Consent - Telehealth		Informed Consent - TelehealthInformed Consent - TelehealthInformed Consent - TelehealthInformed Consent - TelehealthInformed Consent - Telehealth
Telehealth Email Acknowledgement FormTelehealth Email AcknowledgementTelehealth Email AcknowledgementTelehealth Email Acknowledgement Telehealth Email AcknowledgementTelehealth Email AcknowledgementTelehealth Email Acknowledgement
AQIS Continuity of Care Request Form  Adobe Acrobat Icon    
National Voter Registration Act (NVRA) Preference Forms (County Operated Provider Use Only)
National Voter Registration FAQs		 NVRA FormsNVRA Forms NVRA FormsNVRA FormsNVRA Forms
Interpretation Services Poster  NVRA Forms    

Supervision Reporting Forms

Clinical Supervision Reporting Form
*** UPDATED ***		  NVRA Forms    
Clinical Supervisor Agreement (for County Programs only) *** NEW ***  NVRA Forms    
Medical Supervision Reporting Form
*** UPDATED ***		  Acrobat icon    

NOABD

Notice of Adverse Benefit Determination-Delivery SystemWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Notice of Adverse Benefit Determination- Modification NoticeWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Notice of Adverse Benefit Determination- Termination NoticeWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
NOABD Member Non--Discrimination NoticeAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat Icon
Notice of Adverse Benefit Determination- Your Rights NoticeWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Language tagline  Adobe Acrobat Icon    

Car Seat Safety Flyers (County Operated Provider Use Only) 
Notice of Privacy Practices (NPP) (County Operated Provider Use Only) 
Patients' Rights Downloads

For information and resources about the Drug Medi-Cal Organized Delivery System (DMC-ODS), visit http://www.ochealthinfo.com/DMC-ODS