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Documents

In compliance to the Public Records Act, if a document is not available, please contact Mica Olmos at molmos@tricymhs.org to request a copy of the required document.

Information available on this page:

Cultural Competence


Please visit the Diversity, Equity & Inclusion page for more information on plans, annual updates and other DEI-related reports. 

Program Information and Forms

Full-Service Partnership (FSP)

      • FSP Referral and Authorization Form Children (0-15): English | Spanish
      • FSP Referral and Authorization Form TAY (16-25): English | Spanish
      • FSP Referral and Authorization Form Adults (26-59): English | Spanish
      • FSP Referral and Authorization Form Older Adults (60+): English | Spanish


Field Capable Clinical Services (FCCS)

      • Field Capable Clinical Services Referral form for Older Adults 60+: English | Spanish

 

HIPAA Documents


In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was enacted by US Congress to bring about health insurance reform and to ensure that patient health information is not used for any unintended or unauthorized purpose. As part of HIPAA's implementation, any organization providing health-related services that exchanges patient health information electronically must provide its clients with a document that states how the information may be used and their rights concerning its use. That document is called the Notice of Privacy Practices, and is available by clicking the link below:

Notice of Privacy Practices: English | Español
HIPAA Privacy Complaints Form: English | Español


Complaints & Grievances

Consumers who are not satisfied with the services they are receiving are encouraged to let a Tri-City staff member know. The staff will work with the consumer to solve the problem. The consumer will continue to receive the same services, if you choose, while your problem is being resolved. The consumer will not be subject to any penalty for filing a complaint or grievance.

Tri-City has a Complaint Process and a Formal Grievance Process. The consumer may also ask to speak to the Complaint Representative.

Complaint Representative: Natalie Majors-Stewart, Chief Compliance Officer
General Grievance Hotline: (909) 784-3185
Email: issueresolution@tricitymhs.org


Beneficiary/Client Problem Solution Guide: English | Español

Quality Improvement Reports

The TCMH QI Work Plan Goals for FY 14-15 focus on monitoring access to services for target populations, service delivery capacity, timeliness of services provided, language needs to clients, client satisfaction with the services received, the quality of services provided, and other areas of quality improvement as identified by TCMH.

The Quality Improvement (QI) Work Plan provides QI goals and evaluation summary on the progress made by TCMH in reaching each goal.