For your convenience, virtual interviews are available. 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. 1345 0 obj <> endobj You may be trying to access this site from a secured browser on the server. 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. H4 07M% HR>pRY=^Xqd wy0` S. Contact Us Visit Website View Profile. endstream endobj 48 0 obj <>/Subtype/Form/Type/XObject>>stream Submit the original + 2 copies of ALL the completed paperwork to the clerk's office in San Bernardino at 247 W. 3rd Street, 2nd Floor. San Bernardino County 211 get connected. Resource Parents are often called upon to provide information to the child protective services worker, as well as to testify in court. CFS works to prevent further harm to children from physical or mental injury, sexual abuse, exploitation, or neglect. '/*{2 Kl,f9%22Yxr - |Fe w} when an social worker,caseworker at CPS has clearly undermine her family for 8 years & others. The San Bernardino County Department of Child Support Services determines paternity, establishes and enforces child support orders, and secures payments to assist the financial and medical needs of their children. font (English), Adolescent (Age 12-17) and Young Adult ASAM Level of Care Screening. Reports of suspected child abuse or neglect shall be made by mandated reporters to any police department or sheriffs department (not including a school district police or security department), the county probation department (if designated by the county to receive mandated reports), or the county welfare department. endstream endobj 29 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 53 0 obj <>/Subtype/Form/Type/XObject>>stream 0.749023 g f send to the address listed on the form. San Bernardino County Homeless Partnership, Community Action Partnership of San Bernardino County. 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 1. f 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. Strives to protect endangered children, preserve and strengthen their families and develop alternative family settings. Americas largest county. H237402VH2P0P32UT(JJ*2T0T0D|3@.XHT! % 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). 2307rYF You may be trying to access this site from a secured browser on the server. Child Welfare Services Child Abuse Hotline Child Abuse Hotline For more information, or to report suspected child abuse, call 858-560-2191. endstream endobj 47 0 obj <>/Subtype/Form/Type/XObject>>stream Step 2: A Code Enforcement Officer will conduct an exterior inspection of the property to verify compliance with the County's requirements. Requests may be submitted by completing the Request for Judicial Administrative Records Form and sending it to the Court by e-mail or U.S. Mail. endstream endobj 26 0 obj <>/Subtype/Form/Type/XObject>>stream 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.. 21 0 obj <> endobj 2\`q#=csS&c. Report Suspected Child Abuse or Neglect If you suspect that a child's health or safety is jeopardized due to abuse or neglect by parents or other caretaker who has custody of the child, contact the child protective services agency in your county. Most typically, the CPS/DCFS social worker wants to keep you from knowing exactly what you have been accused of sort of keeping themselves on a "general fishing expedition" but it is required by state and federal law to tell you the exact details of the accusations at first contact with . Who should report allegations of abuse or neglect? Below are a few helpful hints on how to navigate . (Courtesy of Eric Bahra) Two children disclosed that the foster father had sexually . To download a form (in PDF format), click on the form number in the appropriate table. Serves veterans and their families and ensure they receive the benefits they have earned. Assistance with Family law, Child support, Landlord/tenant, and more. Complete a Suspected Child Abuse Report (SS 8572 Rev 12/02) for each child that you report and fax it to 909-891-3545 or 909-891-3560. solicitors license in ca in san bernardino county form County of San Bernardino Clerk of the Board of Supervisors ND 385 N. Arrowhead Avenue, 2 Floor, San Bernardino, CA 92415-0130 (909) 387-3841 Fax (909) . 0 f Human Services works to build a healthy community by strengthening individuals and families, enhancing quality of life, and valuing people. Contact us to help you find a path to a $0 balance. endstream endobj 30 0 obj <>/Subtype/Form/Type/XObject>>stream E\i\\ Children and Family Services (CFS) is a department within San Bernardino County dedicated to protecting and promoting the well-being of abused, neglected or exploited children in our county. For graffiti abatement, call 1.877.442.2283. Child Protective Services. San Bernardino, CA 92415-0640 (909)891-9019 . endstream endobj 37 0 obj <>/Subtype/Form/Type/XObject>>stream It is designed to resolve disagreements arising from divorce and legal separation, including provisions for the care of children. Box 1359 Susanville, CA 96130-1359 Website Los Angeles County Department of Children & Family Services 238 0 obj <>stream Strives to provide services, support, protection and conservatorship to older adults, at-risk individuals and adults with disabilities so they may thrive in their communities. E\\y\Fz0\.S=3H!C 9 %%EOF f`a3p8WDT!"kg```P5Bsr San Bernardino County APS strives to have all elders and dependent adults live their lives free from the threat or reality of abuse. APS - Central Intake. Claim Against County of San Bernardino (pdf). f 0.749023 g endstream endobj 27 0 obj <>/Subtype/Form/Type/XObject>>stream Office Configuration Safety Standards (12/18/2018) New! Former foster youth perseveres, becomes veterinarian. 0 0 9 8.625 re Winner of 82 national awards for innovation, efficiency, and public service. 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. f of Industrial Relations web site. To file a claim against the County please complete the form below, print, sign and Adult Protective Services; . endstream endobj 52 0 obj <>/Subtype/Form/Type/XObject>>stream for appropriate follow-up and related document completion. It looks like your browser does not have JavaScript enabled. Child Abuse Hotline (800) 827-8724 Child Abuse Prevention/Safe Kids (909) 383-9677: Child and Family Health . California Family and Domestic Violence Referral Directory. Show details. San Bernardino County Workforce Development Board, Community Policy Advisory Committee (CPAC), Cultural Competency Advisory Committee (CCAC), Behavioral Health Commission (BHC) Meeting is Going Dark. To Report Child Abuse. County Budget Application to Determine CCS Program Eligibility (DHCS 4480, 01/22) endstream endobj 40 0 obj <>/Subtype/Form/Type/XObject>>stream To Report Child Abuse San Bernardino County residents can dial 2-1-1 to anonymously report if they suspect a child is being abused. This automated system provides customers with up-to-date information about their case such as benefit amount, worker information, office location and the ability to request forms to be mailed. H237402VH2P0P007 Please enable scripts and reload this page. 1. Consolidation of Electronic Signature (E-Signature). If not, the site will list the address and phone number of your local courthouse. 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 the san bernardino county sheriff's department, in partnership with california state university of san bernardino and california baptist university, provides evidence-based interventions for inmates to improve family relations, mitigate factors leading to self-destructive life patterns, reduce recidivism, and promote overall healthy functioning Step 1: Apply online through the County's Portal, and submit the $667 initial application fee. If you need to file a claim for Workers Compensation please report to your supervisor f County Job Descriptions and Salaries Use Arrears calculator to figure out balance. ENGLISH SPANISH Change of Provider Request Form - 18pt. Request for Second Opinion Procedure QM6053-1 New! Please be advised that incomplete or inaccurate information may delay the processing of your request. Information on California Workers' Compensation rights and responsibilities )Vice Chairman/SupervisorFirst District, Jesse ArmendarezSupervisorSecond District, Goals and Objectives As a team, Human Services departments collaborate with community partners to provide a wide range of quality programs and services that address the changing and emerging needs of county residents. There are no geographic restrictions. 0 0 7.875 7.5 re Forms & Publications . 1. Help Count the Unsheltered and Make a Difference. Report Waste, Fraud & Abuse, County Job Openings Vice Chairman/Supervisor First District Jesse Armendarez 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. - 18pt not have JavaScript enabled ( 800 ) 827-8724 Child Abuse Prevention/Safe Kids ( 909 ) 383-9677: and! County please complete the form below, print, sign and Adult protective Services.. Address and phone number of your local courthouse of Eric Bahra ) Two children disclosed that foster..., CA 92415-0640 ( 909 ) 383-9677: Child and Family Health delay the processing your... That incomplete or inaccurate information may delay the processing of your local...., preserve and strengthen their families and ensure they receive the benefits they have earned ) and Adult. Format ), click on the server life, and public service had sexually and ensure they receive the they! 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