E\i\\ San Bernardino County residents can dial. Substance Use Disorder and Recovery Services, Services Guide, Directories and Resource Library, Children and Youth Collaborative Services (CYCS), Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (Mandarin), Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (Spanish), Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices (VIE), Change of Provider Request Form 18pt. 0.749023 g 0 0 8.25 8.625 re 0 k Assistance with Family law, Child support, Landlord/tenant, and more. San Bernardino County APS strives to have all elders and dependent adults live their lives free from the threat or reality of abuse. Request for Second Opinion (Spanish) QM048_S Revised! 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 $20 per class *Contact if Bilingual Services needed Precious Life CES 445 S. Arrowhead Ave Ste. To speak to someone about behavioral health services, call 888.743.1478. Where the situation is not an emergency needing the police, reports should be made to the Child Abuse and Neglect Hotline in the following areas: Santa Clara County 24-hour Hotline: 1-833-SCC-KIDS (833-722-5437) San Jose Area: (408 . provides an avenue for reporting fraud, waste, and abuse within SSA's programs and operations. 0 `$ Y"]FjsIodfDxtg0*w*iK vx5Y}p xSm >{TfB@o|H5Kaw0d:4{NCNl(~hY)_^.cmY9qjO c For graffiti abatement, call 1.877.442.2283. for appropriate follow-up and related document completion. f 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). The nature of specific incident(s) you are reportingand, Date(s) and descriptions(s) of the injuries or dangers, Identities of perpetrator(s) and their relationship/s to thechild, Witnesses to the incident(s) and how they may be reached, Details of any physical evidence available, The perpetrator'scurrent access to the child, Present condition/status of the child (for example: inneed of medical attention), Statements from the child(ren) when possible, San Bernardino County Children and Family hbbd```b``" 0i"H`s.8C>nf"Ynu8X8=L?jd &7$+: ,"y3L`qQr&):w4"3p vkJ4 endstream endobj 51 0 obj <>/Subtype/Form/Type/XObject>>stream 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. 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. to resolve your issue through the complaint resolutions listed on the right. 2\`q#=csS&c. 2rLr2Fz@2"c. H*2T0T0342E\\y\FPn.6RBVT+ Mail the completed SS 8572 form to: Child Abuse Hotline P.O. 2\`q#=csS&c. DCS 125 CPS (7/04) Author: L1634 endstream endobj 55 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 44 0 obj <>/Subtype/Form/Type/XObject>>stream Child Abuse Hotline (800) 827-8724 Child Abuse Prevention/Safe Kids (909) 383-9677: Child and Family Health . Use professional pre-built templates to fill in and sign documents online faster. 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. Disaster Response Requirements (02/01/2017) New! endstream endobj 38 0 obj <>/Subtype/Form/Type/XObject>>stream To file a claim against the County please complete the form below, print, sign and send to the address listed on the form. 0.749023 g San Bernardino County size in square miles, Incorporated cities in San Bernardino County, Auditor-Controller/Treasurer/Tax Collector, George Air Force Base: Commemorating Its Legacy 30 Years Later Exhibit. Step 2: Fill out your forms completely. Find your local county office. f Claim Against County of San Bernardino (pdf) County of San Bernardino Employees If you need to file a claim for Workers' Compensation please report to your supervisor for appropriate follow-up and related document completion. and at-risk adults in our county. endstream endobj 29 0 obj <>/Subtype/Form/Type/XObject>>stream 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 Americas largest county. f Take a look back at San Bernardino Countys major accomplishments in 2022, Homeless to Home, a road to self-sufficiency. To Report Child Abuse San Bernardino County residents can dial 2-1-1 to anonymously report if they suspect a child is being abused. Read more at CountyWire. Phone : 800.722.3181 f H237402VH2P0P037U03U(JJ*2T0T0BC#S\.1* e To Report Child Abuse. You may be trying to access this site from a secured browser on the server. 0 k )Vice Chairman/SupervisorFirst District, Jesse ArmendarezSupervisorSecond District, Goals and Objectives Helps at-risk children by improving communication, planning, coordination and collaboration between child serving agencies. The Isaac Lethbridge Story: A Two-Year-Old Killed in a Michigan Foster Home in 2006. e-Prescribing Chart Documentation (12/07/2016) New! 0 0 8.25 9 re Mental Health Consumer Perception Survey-Fall 2019 New! Winner of 82 national awards for innovation, efficiency, and public service. If you need to file a claim for Workers Compensation please report to your supervisor f Adolescent (Age 12-17) and Young Adult (Age 18-20) DMC-ODS Transition New! Child Welfare Services Child Abuse Hotline Child Abuse Hotline For more information, or to report suspected child abuse, call 858-560-2191. 1. Employment Information and Recruitment Videos. 0 0 6.75 7.5 re Two-year-old Isaac Lethbridge died on August 16, 2006 because Child Protective Services social workers took him from his parents and placed him in an unsafe foster home environment. . `AS`8W!L$T1R1!PE b@. T . Welcome to San Bernardino County America's largest county. 2r\.1K 7 Child Abuse Reporting Policy: 05/13/2021 CHD0303 Child Abuse Reporting Procedure . Childrens Interagency Authorization to Exchange Confidential Health Information (PHI) Superseded by COM025_E, Childrens Interagency Authorization to Exchange Confidential Health Information (PHI) (Spanish) Superseded by COM025_S, Therapeutic Behavioral Services Service Assessment, Therapeutic Behavioral Services Risk Assessment, Therapeutic Behavioral Services Referral Form, Childrens Interagency Authorization to Exchange Confidential Health Information (PHI), Childrens Interagency Authorization to Exchange Confidential Health Information (PHI) (Spanish), Child/Adolescent Psychiatric Evaluation and Update, Child/Adolescent Clinical Assessment-CANS-SB, Request to Waive Consumers Responsibility to Pay for Medications, Caregivers Authorization Affidavit (Spanish), Request for Verification of Veterans Status for Mental Health and/or Substance Abuse Services, Consent and Authorization to Exchange Confidential Information for Veterans Status, Medication Support Services Plan (Spanish), Release and Hold Harmless Agreement (Spanish), Interdisciplinary Care Team (ICT) Referral Form, Annual Psychiatric Assessment Review Form, Guidelines for Completing Referral Summary for Referral to Managed Care Plan (MCP) Attachment, Tier Transition Letter Attachment II (Spanish), Beneficiary Nondiscrimination Notice (Spanish), Delivery System Notice (NOABD) (Vietnamese), Delivery System Notice (NOABD) (Mandarin), QM030_S Modification Notice (NOABD) (Spanish), Change of Provider Request Form (Spanish). Read the instructions on the back of the form or on the web site for information on how to fill it out. Find substance use disorders and/or alcohol recovery services? This site uses cookies to enhance site navigation and personalize your experience. Address 150 S. Lena Rd. Try it today! The applicant must submit a completed Interior Checklist & Owner Acknowledgement to . Information on California Workers' Compensation rights and responsibilities CFS values collaboration with community agencies and private citizens to accomplish our mission of protecting children and promoting their well-being. The Court Executive Office's hours are 8:00 a.m. to 5:00 p.m., Monday through Friday, excluding court holidays. Strives to be recognized as a progressive system of seamless, accessible and effective services that promote prevention, intervention, recovery and resiliency for individuals, families and communities. %PDF-1.7 % The California Public Records Act is found in the California Government Code, beginning at Section 6250. Our Family Court division is committed to the processing and management of all domestic matters with integrity, sensitivity and timeliness. Welcome to San Bernardino County's Career Opportunities page! Step 1: Apply online through the County's Portal, and submit the $667 initial application fee. 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 Try it now! 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. http://www.childsworld.ca.gov/res/pdf/CPSEmergNumbers.pdf. San Bernardino County Homeless Partnership, Community Action Partnership of San Bernardino County. PURPOSE OF FORM This form, as adopted by the California Department of Social Services (CDSS), is required under Welfare and Institutions Code (WIC) Sections 15630 and 15658(a)(1). State of California's, Department 9445 Fairway View Place, Suite 110 Rancho Cucamonga, CA 91730 909-948-6200. 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 appropriate Emergency Response Hotline Number For County Child Protective Services to report the details. E\\y\Fz0\.S=3H!C 9 2023 San Bernardino County | . Phone : 909.384.9233 Phone : 800.827.8724 Code Enforcement Hotline The Code Enforcement Division of the Land Use Services Department receives complaints regarding land use, zoning, housing, public nuisances, vehicle abatement, and vegetation or fire hazard abatement. Network Adequacy Requirements and Deadline (03/01/2018), Updated Authorization to Release Protected Health Info, Child and Adolescent Needs and Strengths (CANS)(PSC-35), UCLA Treatment Perceptions Survey Information (9/20/18), Mental Health Consumer Perception Survey Fall 2018. endstream endobj 27 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 39 0 obj <>/Subtype/Form/Type/XObject>>stream Who should report allegations of abuse or neglect? f Get access to thousands of forms. Get ready-made fillable templates for faster form filing and decrease human errors. E\i\\ %PDF-1.6 % endstream endobj 33 0 obj <>/Subtype/Form/Type/XObject>>stream Get the free san bernardino county children and family form cfs 125 cps 2014-2022. . The Adult Protective Services (APS) program is mandated by the State of California. C Get CA CFS 125 CPS - San Bernardino County 2013-2022 Get form. Enroll my Preschooler in a Head Start Program? 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. Office Configuration Safety Standards (12/18/2018) New! 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. 0.749023 g 2rLr2Fz@2"c. Give your local county office your updated contact information so you can stay enrolled. 238 0 obj <>stream A ^ *{Dt8P *7,Jccd0%m3lz%tDE}vdYiBiplo+4 Your computer must have the Adobe Acrobat Reader installed in order to view any of these documents.You will need todownload Adobe Acrobat Readerfrom Adobe's website. 0 IU#q4QCP"@y2P[{[SI(1Yr=MOS`z1 Q`R)d\zOH45|6s5K1)==Aw,13#fR;di$a')0yhLXavVBLjU"5=%PAKaa .IkTf8,MkH63PrQ`5A6LgjZbiT-sIjb$Ujrp[-Dem2S+mL#9by6MZ,U1ejXlFe4&mtN. endstream endobj startxref Welcome to the County of San Bernardino Human Services' website. San Bernardino, CA 92415-0640 (909)891-9019 . endstream endobj 47 0 obj <>/Subtype/Form/Type/XObject>>stream %%EOF Vice Chairman/Supervisor First District Jesse Armendarez 909-484-7667. of Industrial Relations web site. Step 2: A Code Enforcement Officer will conduct an exterior inspection of the property to verify compliance with the County's requirements. To submit a form via email, users must first download the form to their device and then click "submit" on the completed form. Show details. Child and Family Teams (CFTs) During this state of emergency related to the Novel Coronavirus (COVID-19), the CFT process serves as an essential strategy to ensure families and providers can continue caring for children and that the county is aware of the practical and emotional needs of caregivers and children. 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. The forms may be posted on their site. 2. 1. County Code and Charter This year, San Bernardino County settled a lawsuit for $7.5 million in a case that alleged that a county social worker was aware of sexual abuse in the foster care system and failed to report it. Preschool services feeds meals to children. CFS receives and reviews allegations of child abuse and neglect made within San Bernardino County and provides intervention and support services to families and children when those allegations are substantiated. 21 0 obj <> endobj Fraud, Waste, and Abuse Hotline 800.547.9540. County Budget Follow the installation instructions on Adobe's web site to properly install and configure the Acrobat Reader. File a USDA program discrimination complaint? 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. ) New provides an avenue for Reporting fraud, waste, and Abuse within 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