Services

Patients’ Rights

Medi-Cal Beneficiary Publications and 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 the Patients' Rights Office at (213) 738-4949 or (213) 738-4873 if you have any questions or need more information. Read Instructions for Ordering Beneficiary Materials to find out how to get copies of materials.

Beneficiary Guides

• Armenian
• Cambodian
• Chinese Simplified or Chinese Traditional
• English
• Farsi
• Korean
• Russian
• Spanish
• Tagalog
• Vietnamese

Grievance and Appeal Forms and Procedures

• Grievance/Appeal Form – Armenian
• Grievance/Appeal Procedures – Armenian
• Grievance/Appeal Form – Cambodian
• Grievance/Appeal Procedures – Cambodian
• Grievance/Appeal Form – Chinese
• Grievance/Appeal Procedures – Chinese
• Grievance/Appeal Form – English
• Grievance/Appeal Procedures – English
• Grievance/Appeal Form – Farsi
• Grievance/Appeal Procedures – Farsi
• Grievance/Appeal Form – Korean
• Grievance/Appeal Procedures – Korean
• Grievance/Appeal Form – Russian
• Grievance/Appeal Procedures – Russian
• Grievance/Appeal Form – Spanish
• Grievance/Appeal Procedures – Spanish
• Grievance/Appeal Form – Tagalog
• Grievance/Appeal Procedures – Tagalog
• Grievance/Appeal Form – Vietnamese
• Grievance/Appeal Procedures – Vietnamese

Notice of Action

• Notice of Action A (Assessment) in English
• Notice of Action back in English
• Notice of Action A (Assessment) in Spanish
• Notice of Action back in Spanish

HIPAA Complaint Forms