The following are forms for the California Children's Services Program.. Resource Parents are often called upon to provide information to the child protective services worker, as well as to testify in court. )Vice Chairman/SupervisorFirst District, Jesse ArmendarezSupervisorSecond District, Goals and Objectives 1. font (Spanish) 06/28/2022 QM047_S Translation Service Request Form . Child Support Process Understanding Child Support DCSS Services Step-by-Step Process for Child Support Child Support Process Forms 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.. Step 2: A Code Enforcement Officer will conduct an exterior inspection of the property to verify compliance with the County's requirements. 0 0 6.75 7.5 re *CASES IN SAN BERNARDINO COUNTY* Please review the following San Bernardino County sample forms: Form CFS 2w -Grievance Procedures Regarding Placement, Care and Removal of Children Form CFS 7D - Notice of Removal and Grievance Review Request (fill out second page to request a grievance review hearing). get answers. H*2T0T0342E\\y\FPn.6RBVT+ Preschool services feeds meals to children. 0.749023 g endstream endobj 36 0 obj <>/Subtype/Form/Type/XObject>>stream To see if you will need any special, local forms, contact your court clerk or check your court's website. If you are struggling with a juvenile matter involving CFS in San Bernardino or CPS in Riverside, The Haynes Law Firm, APLC is available to provide a consultation regarding your case. 247 West Third Street, 11th Floor. Enhances the quality of life in the community by administrating support programs to persons in need of financial, nutritional and/or medical assistance while working with families and individuals to attain self-sufficiency. Find your local county office. To file a claim against the County please complete the form below, print, sign and send to the address listed on the form. http://www.childsworld.ca.gov/res/pdf/CPSEmergNumbers.pdf. font (Spanish), Opioid Agreement for Buprenorphine Medication Assisted Treatment (Spanish), Opioid Agreement for Buprenorphine Medication Assisted Treatment (English), Beneficiary Nondiscrimination Notice (Mandarin), Beneficiary Nondiscrimination Notice (Vietnamese), Your Rights Attachment (NOABD) (Mandarin), Your Rights Attachment (NOABD) (Vietnamese), Change of Provider Request Form 18pt. Show details. Services are provided in person, by phone, online, and by email. CFS does not supply these forms. The appropriate county CWS agency is the county, in which, the child resides. 9445 Fairway View Place, Suite 110 Rancho Cucamonga, CA 91730 909-948-6200. Who should report allegations of abuse or neglect? Read more at CountyWire. This form documents the information given by the reporting party on the suspected incident of abuse or neglect of an elder or dependent adult. Request for Second Opinion (Spanish) QM048_S Revised! f f The Department of Children and Family Services encourages everyone to report suspected child abuse and neglect, however, certain professions are mandated to report suspected child abuse and neglect. 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 $20 per class *Contact if Bilingual Services needed Precious Life CES 445 S. Arrowhead Ave Ste. Reports of suspected child abuse or neglect shall be made by mandated reporters to any police department or sheriffs department (not including a school district police or security department), the county probation department (if designated by the county to receive mandated reports), or the county welfare department. H*2T0T007U0332U(J E\\y\FAS\.BB1X!S` 1 Samples can be emailed to you by request at: selfhelpforms@sb-court.org. H237402VH2P0P007U332U(JJ*2T0T0\ /"gg$s`*RFpb@. }= San Bernardino Independent: 36: 150 E Holt Blvd, 3rd Floor, Ontario, CA 91762: 909-458-1637: 909-986-2970: San Diego Independent: 37: WHITE COPY-Police or Sheriff's Department; BLUE COPY-County Welfare or Probation Department; GREEN COPY-District Attorney's Office; YELLOW COPY-Reporting Party SS 8572 (12/02) Page 2 of 2 Title H237402VH2P0P007 Read the instructions on the back of the form or on the web site for information on how to fill it out. Employment Information and Recruitment Videos. 0 0 8.25 8.625 re 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. New Medicare Beneficiary Identifier (MBI) New! Office Configuration Safety Standards (12/18/2018) New! f of Industrial Relations web site. %PDF-1.6 % These 24-hour Hotlines are staffed by trained social workers. For your convenience, virtual interviews are available. Disaster Response Requirements (02/01/2017) New! Phone : 800.722.3181 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. 0 0 8.25 9 re 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) . 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. San Bernardino County Workforce Development Board, Community Policy Advisory Committee (CPAC), Cultural Competency Advisory Committee (CCAC), Behavioral Health Commission (BHC) Meeting is Going Dark. Box 1409 San Bernardino, CA 92408. Our number one priority is the prosecution of those responsible for committing crimes within our communities so that the safety and security of others are protected. Address 150 S. Lena Rd. 2\`q#=csS&c. Child Welfare Services Child Abuse Hotline Child Abuse Hotline For more information, or to report suspected child abuse, call 858-560-2191. You may be trying to access this site from a secured browser on the server. 0.749023 g The Department of Children and Family Services encourages everyone to report suspected child abuse and neglect, however, certain professionsare mandated to report suspected child abuse and neglect. Strives to protect endangered children, preserve and strengthen their families and develop alternative family settings. endstream endobj 33 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 44 0 obj <>/Subtype/Form/Type/XObject>>stream Follow the installation instructions on Adobe's web site to properly install and configure the Acrobat Reader. Col. Paul Cook (Ret. . Our Family Court division is committed to the processing and management of all domestic matters with integrity, sensitivity and timeliness. The Hotline is contacted when a member of the community has a concern regarding potential abuse or neglect of a child. Mail the completed SS 8572 form to: Child Abuse Hotline P.O. to anonymously report if they suspect a child is being abused. endstream endobj 50 0 obj <>/Subtype/Form/Type/XObject>>stream H*2T0T007 San Bernardino County - Local Forms Downloading & Viewing Directions Your computer must have the Adobe Acrobat Reader installed in order to view any of these documents.You will need to download Adobe Acrobat Reader from Adobe's website. 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. File a USDA program discrimination complaint? The applicant must submit a completed Interior Checklist & Owner Acknowledgement to . San Bernardino County residents can dial. f Fraud, Waste, and Abuse Hotline 800.547.9540. Box 1359 Susanville, CA 96130-1359 Website Lassen County Health & Social Services Agency Ms. Barbara Longo, Director P.O. 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. Use professional pre-built templates to fill in and sign documents online faster. The reporter's identity is confidential, but a name should be given so the Department could follow-up contact with the reporter if necessary. Easily fill out PDF blank, edit, and sign them. 0.749023 g 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. Services agency Ms. Barbara Longo, Director P.O staffed by trained social workers to children access this site a... For more information, or to report suspected child abuse Hotline P.O SS 8572 form to child... 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