The releasor authorizes his/her employer to release employment references including, but limited to, his/her employment history and wages and any information which may be requested relative to his/her employment, employment applications, and other related matters, and to furnish copies of any and all records which the employer may have regarding his/her employment.
Release Of Information Form Mental Health In Contra Costa
Category:
State:
Multi-State
County:
Contra Costa
Control #:
US-00458
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
Service Provider Individualized Recovery Intensive Training (SPIRIT) is a college accredited recovery oriented, peer led classroom and experiential-based program for individuals with lived behavioral health experience as a client/consumer or a family member.
1-877-661-6230 The Advice Nurse can tell you if you need to go to urgent care or the emergency room, give you self-care instructions, schedule a telehealth appointment with a doctor, and more! Available 24 hours a day, 7 days a week, 365 days a year. (For medical emergencies, please call 911.)
Ways to File a Grievance or Appeal Call Member Services, Monday – Friday, 8am – 5pm at 1-877-661-6230 (Option 2) (TTY 711). If you have a clinically urgent issue, you can also reach our 24-Hour Nurse Advice Line at 1-877-661-6230 (Option 1).
Call Health Care Options at 1-800-430-4263 to request your Medi-Cal Choice Enrollment Form. Look for the Medi-Cal Choice enrollment form in the booklet. You can also send in the postcard that you received from Health Care Options to get your Medi-Cal Choice form.
Contact Contra Costa Health Medi-Cal. If you have Medi-Cal questions, please visit Contra Costa Employment & Human Services (EHSD) or call 1-866-663-3225. Environmental Health. Use the Environmental Health Complaints page for restaurant, industrial or similar complaints. Health Plan. Telephone. Email/Online Form.
Simply submit your information, and we'll get back to you about if you qualify for Medi-Cal through Covered California. This is your fastest option if you're interested in signing up for Medi-Cal.
Identity Copy of driver's license or photo ID. Social Security Number (actual card) A copy of immigration documentation or card.
