Forms for Staff and Providers   


    Service Provider Identification

    Staff Re-Credentialing

    Integration/Separation

    Alcohol and Drug Program

    Drug Medi-Cal

     Mental Health and Drug Medi-Cal

    Please ensure that the following three forms are attached to each NOABD issued to beneficiaries:

    Clinician's Gateway

    ShareCare

    CSI

      AUTHORIZATION FORMS

      Note Review Requests

      TBS    

      IHBS  Intensive Home Based Services