San Bernardino County 211 get connected. f Adult Protective Services; . Substance Use Disorder and Recovery Services Policy, Substance Use Disorder and Recovery Services Procedure, Naloxone Intranasal Distribution Procedure, Client Tuberculosis (TB) Testing and Services Policy, Client Tuberculosis (TB) Testing and Services Procedure, myAvatar Electronic Health Records Policy, myAvatar User Account Creation and Reinstatement Procedure, myAvatar User Account Modification Procedure, myAvatar User Account Deactivation Procedure, Criteria for Beneficiary Access to SMHS Medical Necessity and other Requirements, No Wrong Door for Mental Health Services Policy, Revised Mental Health Co-Staffing Chart Documentation a, Personal Protective Equipment (PPE) for DBH Programs, Quality Management Chart Documentation Guidance due to, New Classification of Other Qualified Providers, Coronavirus (COVID-19) Information for DBH Workforce, Mental Health Consumer Perception Survey Spring 2019, DMC-ODS UCLA Treatment Perception Survey-October 2019, Notice of Changes to EPSDT Data Collection Requirements, Editing Notice of Adverse Benefit Determination (NOABD). To speak to someone about behavioral health services, call 888.743.1478. endstream endobj 41 0 obj <>/Subtype/Form/Type/XObject>>stream The Department of Children and Family Services encourages everyone to report suspected child abuse and neglect, however, certain professions are mandated to report suspected child abuse and neglect. Missing payments increase your amount owed. Strives to provide services, support, protection and conservatorship to older adults, at-risk individuals and adults with disabilities so they may thrive in their communities. )Vice Chairman/SupervisorFirst District, Jesse ArmendarezSupervisorSecond District, Goals and Objectives 0 k Submit the original + 2 copies of ALL the completed paperwork to the clerk's office in San Bernardino at 247 W. 3rd Street, 2nd Floor. The reporter's identity is confidential, but a name should be given so the Department could follow-up contact with the reporter if necessary. You do not need to mail the original. Office Configuration Safety Standards (12/18/2018) New! to resolve your issue through the complaint resolutions listed on the right. Complete a Suspected Child Abuse Report (SS 8572 Rev 12/02) for each child that you report and fax it to 909-891-3545 or 909-891-3560. County Operator General County Information Telephone: Toll Free (888) . Get e-mail updates on the latest COVID-19 news. Use professional pre-built templates to fill in and sign documents online faster. 0.749023 g Strives to be recognized as a progressive system of seamless, accessible and effective services that promote prevention, intervention, recovery and resiliency for individuals, families and communities. Childrens Interagency Authorization to Exchange Confidential Health Information (PHI) Superseded by COM025_E, Childrens Interagency Authorization to Exchange Confidential Health Information (PHI) (Spanish) Superseded by COM025_S, Therapeutic Behavioral Services Service Assessment, Therapeutic Behavioral Services Risk Assessment, Therapeutic Behavioral Services Referral Form, Childrens Interagency Authorization to Exchange Confidential Health Information (PHI), Childrens Interagency Authorization to Exchange Confidential Health Information (PHI) (Spanish), Child/Adolescent Psychiatric Evaluation and Update, Child/Adolescent Clinical Assessment-CANS-SB, Request to Waive Consumers Responsibility to Pay for Medications, Caregivers Authorization Affidavit (Spanish), Request for Verification of Veterans Status for Mental Health and/or Substance Abuse Services, Consent and Authorization to Exchange Confidential Information for Veterans Status, Medication Support Services Plan (Spanish), Release and Hold Harmless Agreement (Spanish), Interdisciplinary Care Team (ICT) Referral Form, Annual Psychiatric Assessment Review Form, Guidelines for Completing Referral Summary for Referral to Managed Care Plan (MCP) Attachment, Tier Transition Letter Attachment II (Spanish), Beneficiary Nondiscrimination Notice (Spanish), Delivery System Notice (NOABD) (Vietnamese), Delivery System Notice (NOABD) (Mandarin), QM030_S Modification Notice (NOABD) (Spanish), Change of Provider Request Form (Spanish). To Report Child Abuse. Follow the installation instructions on Adobe's web site to properly install and configure the Acrobat Reader. 247 West Third Street, 11th Floor. However. `Sp8WrU B Reporting Medical Conditions and Communicable Diseases, Pill Organizers for DBH Clients (11/06/2015), ICD-10 Diagnosis and Procedure Code Transition, State Requirements for Treatment Authorization Requests, Electrical Safety: Personal Appliances (04/11/2014), Medication Policy and Procedure (11/20/2013), Prepaid Debit Cards/Bus Pass Continuous Written Log, Use of Electronic Signatures (04/22/2010), Use of Episode Closing Codes (03/02/2009), IN 15-01 Non-use of Blood Glucometers (06/02/2015), IN 13-01 Disclosure of Ownership (03/18/2013). The Department of Children and Family Services encourages everyone to report suspected child abuse and neglect, however, certain professionsare mandated to report suspected child abuse and neglect. 1435 0 obj <>/Encrypt 1346 0 R/Filter/FlateDecode/ID[<335AAE7A7B830041B320609C06D4D458><59DEEA9921E0A542ADF5998D03769A5E>]/Index[1345 242]/Info 1344 0 R/Length 160/Prev 807907/Root 1347 0 R/Size 1587/Type/XRef/W[1 3 1]>>stream 0 It looks like your browser does not have JavaScript enabled. H*2T0T0 Once completed, the request form may be emailed (preferred method) as an attachment to CPSGatekeeper@saccounty.gov . PURPOSE OF FORM This form, as adopted by the California Department of Social Services (CDSS), is required under Welfare and Institutions Code (WIC) Sections 15630 and 15658(a)(1). You may be trying to access this site from a secured browser on the server. H237402VH2P0P Records of San Bernardino County which are not exempt from disclosure are available for inspection and copying in accordance with the California Public Records Act upon a request that reasonably describes an identifiable record or records. endstream endobj 28 0 obj <>/Subtype/Form/Type/XObject>>stream ,&?(bYY Vb4*LgPr`2GH X, 9974|3/ Wy8L@O q][Wk9URk#w+mr5A! Winner of 82 national awards for innovation, efficiency, and public service. San Bernardino, CA 92415-0640 (909)891-9019 . Call (833) 526-5197 to schedule a consultation to get your immediate questions answered and get the legal representation you need. 0 0 7.875 8.625 re endstream endobj 43 0 obj <>/Subtype/Form/Type/XObject>>stream Registration process. endstream endobj 50 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 51 0 obj <>/Subtype/Form/Type/XObject>>stream Website and at-risk adults in our county. H237402VH2P0P007 http://www.childsworld.ca.gov/res/pdf/CPSEmergNumbers.pdf. E\i\\ 0.749023 g . Health and Human Services Public Safety and Justice Community Services Recreation and Culture Government Services Board of Supervisors Col. Paul Cook (Ret.) Please turn on JavaScript and try again. To file a claim against the County please complete the form below, print, sign and endstream endobj 40 0 obj <>/Subtype/Form/Type/XObject>>stream provides an avenue for reporting fraud, waste, and abuse within SSA's programs and operations. Other useful information can be accessed from the menu by clicking the links to a variety of topics. Please enable scripts and reload this page. DV, child abuse, sex offender classes Youth Hope, Inc. 255 N. "D" St, Suite 302 San Bernardino 92401 (909)567-2808 Family Service Agency 1661 North "E" Street San Bernardino 92405 (909) 886-6737 Adult classes now offered $20 per class *Contact if Bilingual Services needed Precious Life CES 445 S. Arrowhead Ave Ste. San Bernardino County residents can dial. Covering 20,105 square miles, San Bernardino County is Americas largest county and a diverse public service organization governed by an elected Board of Supervisors and serving a community of nearly 2.2 million residents. endstream endobj 22 0 obj <> endobj 23 0 obj <> endobj 24 0 obj <> endobj 25 0 obj <>/Subtype/Form/Type/XObject>>stream In alignment with the Countywide Vision to create a county in which those who reside and invest are able to prosper and achieve well-being, Human Services works to build a healthy community by strengthening individuals and families, enhancing quality of life and valuing people. font (Spanish), Opioid Agreement for Buprenorphine Medication Assisted Treatment (Spanish), Opioid Agreement for Buprenorphine Medication Assisted Treatment (English), Beneficiary Nondiscrimination Notice (Mandarin), Beneficiary Nondiscrimination Notice (Vietnamese), Your Rights Attachment (NOABD) (Mandarin), Your Rights Attachment (NOABD) (Vietnamese), Change of Provider Request Form 18pt. *CASES IN SAN BERNARDINO COUNTY* Please review the following San Bernardino County sample forms: Form CFS 2w -Grievance Procedures Regarding Placement, Care and Removal of Children Form CFS 7D - Notice of Removal and Grievance Review Request (fill out second page to request a grievance review hearing). Step 2: A Code Enforcement Officer will conduct an exterior inspection of the property to verify compliance with the County's requirements. San Bernardino, CA 92415. 0.749023 g This form documents the information given by the reporting party on the suspected incident of abuse or neglect of an elder or dependent adult. Strives to protect endangered children, preserve and strengthen their families and develop alternative family settings. Who live or work in San Bernardino County, Through San Bernardino County Homeless Veterans Initiative. Application for Services Forms Application for Child Support Services Complete the CPS Records Request Form below and fill it out with as much information as possible. Employment Information and Recruitment Videos. Ergonomic Assessment Level (12/12/2018) New! 0 solicitors license in ca in san bernardino county form County of San Bernardino Clerk of the Board of Supervisors ND 385 N. Arrowhead Avenue, 2 Floor, San Bernardino, CA 92415-0130 (909) 387-3841 Fax (909) . If not, the site will list the address and phone number of your local courthouse. (Courtesy of Eric Bahra) Two children disclosed that the foster father had sexually . H237402VH2P0P32f@(+PP$j 2rMMrFz@^T)T!Q` R Enhances the quality of life in the community by administrating support programs to persons in need of financial, nutritional and/or medical assistance while working with families and individuals to attain self-sufficiency. The nature of specific incident(s) you are reportingand, Date(s) and descriptions(s) of the injuries or dangers, Identities of perpetrator(s) and their relationship/s to thechild, Witnesses to the incident(s) and how they may be reached, Details of any physical evidence available, The perpetrator'scurrent access to the child, Present condition/status of the child (for example: inneed of medical attention), Statements from the child(ren) when possible, San Bernardino County Children and Family 0.749023 g f endstream endobj startxref Information on California Workers' Compensation rights and responsibilities Standing Order Requirement for Administering NARCAN. 0 0 8.25 9 re H*2T0T007 2. Within the State of California you may call toll free 1 (800) 344-6000. Child Abuse Hotline for San Bernardino County is 1 (800) 827-8724 Child Protective Services (CPS) Hotlines: CPS Hotlines for all 58 counties in California. e-Prescribing Chart Documentation (12/07/2016) New! endstream endobj 35 0 obj <>/Subtype/Form/Type/XObject>>stream County Job Descriptions and Salaries SAN BERNARDINO COUNTY CHILD AND FAMILY SERVICES - CHILD PROTECTIVE SERVICES The program provides child protective services for San Bernardino County. 2\`q#=csS&c. f He was beaten and burned while in state custody foster "care". 2rLr2Fz@2"c. endstream endobj 38 0 obj <>/Subtype/Form/Type/XObject>>stream 0.749023 g Lassen County Community Social Services Department & Children & Family Services Ms. Jenna Ducasse, Director P.O. The Job of the County of San Bernardino is to create a county in which those who reside and invest can prosper and achieve well-being. Use Arrears calculator to figure out balance. If you suspect that a child has been, or is in danger of, abuse or neglect , contact the county Children's Protective Services 24-hour emergency response phone. Please enable scripts and reload this page. Where the situation is not an emergency needing the police, reports should be made to the Child Abuse and Neglect Hotline in the following areas: Santa Clara County 24-hour Hotline: 1-833-SCC-KIDS (833-722-5437) San Jose Area: (408 . 2018 Superior Court of California, County of San Bernardino, All Rights Reserved |, COVID-19: COURT OPERATIONS DURING THE COVID-19 PANDEMIC, Family Court Services Orientation Class Info, Failure to Appear/Respond to a Jury Summons, Court Case Information and Document Sales, How to Navigate San Bernardino Superior Court, San Bernardino Superior Court Rules of Practice, Local Emergency Rules Related to COVID-19, Online Form Preparation and Filing (TurboCourt), Online Form Preparation and eFiling (TurboCourt), Stipulation For Settlement (CCP 664.6) (fillable), Proof of Service Notice of Appeal (Code Enforcement), Appeal Procedures for Unlimited Civil Cases (Information on), Declaration of Petitioner and Request for Records Check, General Civil Case At-Issue Memorandum (fillable), Declaration and Order Re: Satisfaction of Judgment, CONFIDENTIAL Referral for CII/Carpos/ICMS Report (Civil) - Form A, Order Request for Review of Denial of Request to Remove Name from Gang Database, Initial Trial Setting Conference Statement, Application for Diversion of Individual with Mental Disorder, Order on Application for Diversion of Individual with Mental Disorder, Declaration and Order for Release of Exhibits, Consent to Bring Prohibited Items into the Courthouse as Exhibits (fillable), Stipulation And Order On Request For Order, Referral for CII/CARPOS/ICMS Report (fillable), Family Law At-Issue Memorandum for Trial Setting, Declaration And Order For Issuance Of Writ Of Execution/Abstract Of Judgment (fillable), Order On Petition For Grandparent Visitation, Response To Petition For Grandparent Visitation, Declaration Re: Compliance with Custody Orders (fillable), Petition for Declaring Child(ren) Free from Parental Custody and Control, Citation - Freedom from Parental Custody and Control, Order Declaring Child(ren) Free from Parental Custody and Control, Order on Petition to Terminate Parental Rights of Alleged Father, Petition to Terminate Parental Rights of Alleged Father, Declaration and Order Dispensing with Notice to Alleged Father, Petition to Obtain Original Unsealed/Un-Redacted Birth Certificate, Order on Petition to Obtain Original Unsealed/Un-Redacted Birth, Order on Petition for Birth Record Information, Application to Obtain Final Adoption Order and Order, Application to Obtain Copies from Adoption Case and Order, Petition for Adoption of Adult or Married Minor, Agreement of Adoption of Adult or Married Minor, Consent of Spouse of Adult or Married Minor to be Adopted, Stipulation for Entry of Judgment Re: Establishment of Parental Relationship, Order for Publication of Citation (Adoption), Application for Order for Publication of Citation (Adoption), Notice of Continuance of Hearing (Family Law), Declaration Regarding Objection to Agreement, Family Law/Child Support Copy Request Form, Affidavit/Certificate/Declaration Re: Military Service in an Adoption and Related Matters, Order for Publication of Summons or Citation, Application for Publication of Summons or Citation, Request for Dismissal -- Small Claims Cases, Declaration of Mailing or Inability to Ascertain Address (fillable), Request to Excuse Notice with Due Diligence Declaration, Audio CD Information Sheet and Order Form, Petition for Release of Jury Records and Order, Objection/Response to Packet (Delinquency), Objection/Response to Packet (Dependency), Certification of Competency (Delinquency), Response to Petition for Resentencing (Juvenile), Proof of Service - Juvenile Restraining Order, Ex Parte Application And Order To Serve Summons By Posting, Application for Judgment for Restitution of Premises Only (CCP1169) (fillable), Pretrial Orders Judgment By Court Unlawful Detainer (fillable), To Set Case for Trial - Unlawful Detainer, Application for Issuance of Writ of Execution Per CCP 712.010, Small Claims/Landlord Tenant Copy Request Form, Order Appointing Counsel For Conservatee, Probate Code Sections 1470, 1471, and 2356.5(f)(1), Petition for Visitation (Guardianship Cases Only), Order on Petition for Visitation (Guardianship Cases Only), Order Appointing Counsel For Minor, Probate Code Sections 1470 and 1516.5 (fillable), Notification of Court of Conservatorship Address, Confidential Guardianship Questionnaire and Authorization for Release of Information, List of Required Contact Information for Conservatorships, Optional Attachment to List of Required Contact Information for Conservatorships, Confidential General Care Plan of Conservatee, Ex Parte Petition to Dispense with Accounting and Order (fillable), Request for Deferment of Court Investigator Fee and Order, Affidavit to Comply with California Probate Code 13100-13115, Termination of Guardianship - Parent Questionnaire, Notification of Disqualification from Voting, Notice of Commencement of Proceedings for a Court Supervised Trust, Confidential Information Sheet - Conservatorship, Confidential Information Sheet - Guardianship, Confidential Information Sheet - Intestate Probate, Confidential Information Sheet - Testate Probate, Confidential Information Sheet - Trust Matters, Request for Consideration of Ability to Pay, Waiver of Arraignment & Court Trial Setting. 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