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Medi-Cal Beneficiary Publications & Forms

Below are the links to the "Guide to Medi-Cal Mental Health Services" in several languages. All are in PDF file format and require an Adobe Acrobat Reader to view and print. Also available on this page are the Beneficiary Client Grievance Forms (English and Spanish) and the Grievance Appeal Procedures Brochures (English and Spanish). Please contact Patients' Rights Office at (213) 738-4949 or (213) 738-4873 if you have any questions or need more information.

Guides	Grievance Publications
Armenian	Grievance/Appeal Form - Armenian	Grievance/Appeal Procedures- Armenian
Cambodian	Grievance/Appeal Form Cambodian	Grievance/Appeal Procedures - Cambodian
Chinese Simplified	Grievance/Appeal Form Chinese	Grievance/Appeal Procedures Chinese
Chinese Traditional	Grievance/Appeal Form - English	Grievance/Appeal Procedures - English
English	Grievance/Appeal Form Farsi	Grievance/Appeal Procedures Farsi
Farsi	Grievance/Appeal Form Korean	Grievance/Appeal Procedures Korean
Korean	Grievance/Appeal Form Russian	Grievance/Appeal Procedures Russian
Spanish	Grievance/Appeal Form - Spanish	Grievance/Appeal Procedures - Spanish
Tagalog	Grievance/Appeal Form - Tagalog	Grievance/Appeal Procedures Tagalog
Vietnamese	Grievance/Appeal Form - Vietnamese	Grievance/Appeal Procedures Vietnamese

	HIPAA Forms
	Armenian HIPAA Form	Korean HIPAA Form
	Cambodian HIPAA Form	Russian HIPAA Form
	Chinese HIPAA Form	Tagalog HIPAA Form
	Farsi HIPAA Form	Vietnamese HIPAA Form


Memo to All MH Service Providers: Ordering Materials NOA-A Form

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