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Resource Documents

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For All Providers

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All Provider Contact List as of 08/29/17 All Provider Contact List pdf.
250% California Working Disabled Program 07/31/14

California Working Disabled

AIDS Institute Online Training Resource as of 04/13/17                 
CDPH Potential Data Breach FAQ as of 04/13/17

CA DOJ Consumer Tips: CA DOJ Breach Help as of October 2014
                
            (FAQ)

          
Health Care Agency Adult and Older Adult Behavioral Health Services
SUD Contracted Treatment Providers Contact List as of 07/17/15

SUD Contracted Contacts

OC Accept

Out of Jurisdiction Resources for Case Managers 06/22/17               California Working Disabled
Orange County's Healthier Together

Overview of Orange County HIV Grant-Funded Services and Providers as of 07/21/16

Overview of County of Orange Mental Health Services Act Services (Adobe Acrobat version)

Overview of Invoice Submission 04/13/17                 
HIV PrEP (HIV Pre-Exposure Prophylaxis) Guide as of 08/26/15

PrEP Guide - Acrobat PDF version

CDPH Webinar: PrEP for HIV Prevention: Update and Provider Experiences


(Streaming link)

(Download link)

HIV PrEP Program Presentation 04/14/16

PrEP Program Presentation

HIV PrEP Program Factsheet 04/14/16

PrEP Program Factsheet



Housing Plus Project Flyers


ASF English

 
ASF Spanish

 
APAIT


Housing Plus Project Overview for Service Providers as of 10/20/16

Registration Form (English)

Registration Form (Spanish)

Medical Detox Information (Flyer) as of 11/10/16

Registration Form

Disease Intervention Services, Outreach, PrEP Quarterly Reports
Disease Intervention Services Report, January 2017                 Registration Form
Outreach Report, January 2017                 Registration Form
PrEP Report, February 2017                 Registration Form

Tools for Care Providers

ARTAS Linkage Case Management


The following YouTube videos correspond to the five (5) sessions from the ARTAS participant manual.


Session 1/Intro - https://www.youtube.com/watch?v=fi8qF-3HAWI

Session 2 - https://www.youtube.com/watch?v=cKdbGhXk5aw

Session 3 - https://www.youtube.com/watch?v=PBaJw5RT2iE

Session 4 - https://www.youtube.com/watch?v=oVfKWV3HGpM

Session 5/Close - https://www.youtube.com/watch?v=a2v97Kf-pMo

ARTAS - Case Staffing Form and Instructions

ARTAS - Client Satisfaction Questionnaire

ARTAS - Session Notes Form and Instructions

ARTAS - Session Notes Summary Sheet and Instructions

English

ARTAS - Session Plan Form and Instructions

ARTAS - Strengths Assessment Form and Instructions

ARIES

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ARIES Advisor Newsletters
ARIES Handbook 2015
ARIES Required and Recommended Data Fields as of 04/13/17

ARIES Required and Recommended Data Fields - Acrobat PDF version

ARIES Service Unit Guide as of 12/01/16

Sample ARIES consent forms

Definitions for ARIES Client Status

Instructions for Completing ARIES Consent Form as of 04/15/14

Instructions for Completing ARIES Consent Form as of 4/15/14

ARIES Decision Tree as of 2/06/2014

ARIES Decision Tree

ARIES Screen Shots for Eligibility Verification as of 01/27/14

ARIES Screen Shots for Eligibility Verification Acrobat pdf.

ARIES Registration Form as of as of 06/15/15

ARIES Registration Form

Memo: Implementation of ARIES Share Status as of 08/20/13

Memo: Implementation of ARIES Client Share Status - Acrobat PDF version

ARIES Client Information Sheets as of 07/10/12

English ARIES Client Information Sheet English - Acrobat PDF version
Spanish ARIES Client Information Sheet Spanish - Acrobat PDF version

ARIES Client Search and Share Status as of 07/10/12

ARIES Client Search and Share Status - Acrobat PDF version

ARIES Consent Forms 07/2010

English ARIES Consent Form English- Acrobat PDF version
Spanish ARIES Consent Form Spanish- Acrobat PDF version

ARIES Consent Form Sample Sample ARIES consent forms
ARIES Consent Form Reminders as of 11/15/16 Sample ARIES consent forms
ARIES Reminders for Centralized Eligibility as of 12/10/13 ARIES Reminders for Centerlized Eligibility
ARIES Case Management Data Entry Guide as of 03/01/16 RW CM Data Entry
ARIES User FAQs

CalOptima Resources

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AltaMed Medical-CalOptima New Patient FAQ
CalOptima Medi-Cal Networks and Providers Accepting HIV+ Patients List as of 11/25/15 CalOptima Medi-Cal Network ID

Important Dates

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Care and Housing Provider Important Dates 2017 as of 04/03/17

Prevention Provider Important Dates - Acrobat PDF version

Prevention Provider Important Dates 2017 as of 04/03/17

Prevention Provider Important Dates - Acrobat PDF version

Eligibility

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ARIES Reminders for Centralized Eligibility as of 12/10/2013 ARIES Reminders for Centerlized Eligibility
ARIES Screen Shots for Eligibility Verification as of 1/27/2014 ARIES Screen Shots for Eligibility Verification Acrobat pdf.
Memo: Centralized Eligibility as of 12/10/2013 Memo: Centralized Eligibility
Centralized Eligibility Presentation as of 12/10/13
Disability Definitions as of 11/05/2013 Disability Definitions Acrobat pdf.
Required Eligibility and Program Overview as of 4/15/2014 Required Eligibility and Program Overview
Spanish Required Eligibility and Program Overview as of 4/15/2014 Spanish Required Eligibility and Program Overview
Vietnamese Required Eligibility and Program Overview as of 7/01/2015 Vietnamese Required Eligibility and Program Overview

Eligibility and qualifying requirements as of 09/18/17:

  • Ryan White/HOPWA Requirements to be eligible and qualify for services
  • Overview of Services that Require a Referral
  • Poverty Links




Ryan White/HOPWA Requirements and Poverty Links
Centralized Eligibility Screening  Process FAQs Centralized Eligibility Screening Process FAQs

Templates

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Care Services 2017 Site Visit Tool as of 02/09/17

Site Visit

Care Services 2017 Site Visit Changes (cheat sheet) as of 02/09/17

Site Visit Cheat Sheet

Housing Services 2016 Site Visit Tool as of 03/11/17 Site Visit Tool
Housing Services 2016 Site Visit Changes (cheat sheet) as of 03/11/17 Site Visit Cheat Sheet
17th Street Eligibility Verification Information Request Form as of 11/05/14

English

English

ASF Eligibility Verification Information Request Form as of 11/05/14

English

English

Shanti Eligibility Verification Information Request Form as of 11/05/14

English

Eligibility Verification Form

Self-Attestation Form Instructions as of 5/13/14

Self-Attestation Form Instructions

17th Street Self-Attestation Form as of 11/05/14

English

English

17th Street Spanish Self-Attestation Form as of 11/05/14

Spanish

Spanish

17th Street Vietnamese/Việt Self-Attestation Form as of 11/05/14

Vietnamese

Vietnamese

ASF Bus Pass and ACCESS coupons request form as of 05/03/17                 
ASF Release for Bus Pass 05/18/17

        ASF English SA Form

ASF Core Nutrition Services form rev 05/03/17

ASF English SA Form

ASF Self-Attestation Form as of 11/05/14

English

ASF English SA Form

ASF Spanish Self-Attestation Form as of 11/05/14

Spanish

Spanish SA Form

ASF Vietnamese Self-Attestation Form as of 11/05/14

Vietnamese

English SA Form

Ryan White Case Management Individual Service Plan - 03/01/16 English SA Form

Ryan White Case Management Psychosocial Assessment Acuity Tools:
as of 02/16/17



(Ryan White Combined Tool)


(Case Management Only) 


(Linkage to Care Only)

Ryan White Case Management Psychosocial Follow-Up Tool
Ryan White Eligibility Verification Form Supplemental English

English SA Form
Shanti Self-Attestation Form as of 11/16/15 English

English SA Form
Shanti Spanish Self-Attestation Form as of 11/16/15 Spanish

Spanish SA Form
Shanti Vietnamese Self-Attestation Form as of 11/16/15 Vietnamese

Vietnamese SA Form

Care Services Biannual Narrative Report Template as of 08/17/17

HIV Services Quarterly Narrative Report Template
Housing Services Biannual Narrative Report Template as of 01/06/15 HOPWA Biannual Narrative Report Template
Housing Services Year End Narrative Report Template as of 01/06/15 HOPWA Year End Narrative Report Template

Referral Process and Templates

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5 Reminders for Completing Referrals as of 2/11/16 Five Reminders for Completing Referrals as of 4/15/14
AltaMed Registered Dietician Referral Form as of 2/2014

AIDS Services Foundation (ASF) EFA for Housing Referral Form as of 10/28/13

ASF EFA Referral

ASF Food Pantry Referral Form as of 05/03/17
ASF Home Delivered Meals and/or Nutritional Supplements Assessment and Referral as of 04/01/17 ASF MH Referral Form
ASF Local Drug Medication Financial Eligibility Screening as of 11/05/13 ASF Local Drug Medication Financial Eligibility Screening
ASF Local Drug Health Insurance Payment Assistance Form as of 11/05/13 ASF Local Drug Health Insurance Payment Assistance
ASF Manufactures Patient Assistance Program (MPAP) Eligibility Form as of 11/7/13 ASF MPAP Eligibility Form
ASF Medical Nutrition Therapy Referral 04/2017 ASF MH Referral Form
ASF Mental Health Template as of 8/01/14 ASF MH Referral Form
ASF Nursing Referral Template as of 11/24/15 ASF Nursing Referral
ASF Nutrition Services Referral Form as of 02/29/16 ASF Nutrition Referral
ASF Pharmacy Payment Authorization as of 4/2008 ASF Local Drug Pharmacy Payment Authorization
ASF Physician' Recommendation for Nutritional Supplements as of 12/12/13 Nutritional Supplements Form
ASF Transitional Housing Program Information and Referral Form as of 09/01/17 ASF Transitional Housing Program Information
ASF Transportation Services Referral Form as of 06/08/17
APAIT Food Pantry Referral Form as of 05/18/17
APAIT Mental Health Referral Form 8/1/14 MH Assessment
APAIT EFA for Housing Referral Form as of 10/30/13 APAIT Emergency Housing Program Referral
APAIT Transitional Housing Information and Referral as of 09/01/17
Case Management Referral Form (Fillable) as of 06/01/17 CM Referral Form
Linkage to Care Insurance Referral Q&A as of 03/01/16 LTC Ins Referral Q&A
Linkage to Care Referral Form (Fillable) as of 08/24/17 LTC Referral Form
Linkage to Care Referral Protocol and Instructions 02/16/17 Five Reminders for Completing Referrals as of 4/15/14
(17th St.)

Five Reminders for Completing Referrals as of 4/15/14
(Providers)
Medical Retention Services Exemption Form 09/14/16 LTC Referral Form
Mental Health Assessment Tool as of 08/04/16 LTC Referral Form
Mental Health Group Sign-In Template as of 03/1/16 Mh Group Sign In
Mental Health Service Authorization Form as of 2/09/15 MH Authorization
Prevention Referral Instructions as of 08/03/17 Prevention Referral
Prevention Referral as of 08/03/17
Prevention Referral
Prevention Referral Spanish as of 08/03/17
Prevention Referral
Prevention Referral Vietnamese as of 08/03/17
Prevention Referral
Psychiatric Referral Form as of 2/07/12 Psychiatric Referral
Prevention Referral
Public Law Center Referral Form as of 11/13 PLC Referral
Ryan White Dental Referral Process for Providers as of 07/01/17 Ryan White Dental Referral Process for Providers
Ryan White Dental Referral Form as of 07/01/17

Ryan White Dental Referral Do's and Dont's as of 04/13/17                 Ryan White Dental Referral Process for Providers
Sample Justifications for EFA-Housing as of 4/15/2014 Sample Justifications for EFA Housing
START House Transitional Housing Referral Form as of 1/06/2014 Start House Referral
SUD Treatment Client Information as of 4/14/2015 SUD Treatment Client Info
SUD Treatment Authorization Form as of 4/14/2015 SUD Treatment Auth

Presentations and Fact/Data Sheets

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Overview of Changes to Case Management 03/01/16 RW CM Overview of Changes
SUD Treatment Referral Presentation 7/30/2015
Linkage to Care Overview 2/05/2015
Linkage to Care Report 2/05/2015
National HIV/AIDS Strategy Orange County Update
Orange County Prevention Progress Report OC Prevention Progress Report
Barriers to Testing Presentation 7/31/14 Barriers to testing Presentation
  • Barriers to Testing Overview Handout 7/31/14
Barriers to testing Handout
Affordable Care Act Update 4/15/2014 ACA Update
Expanded Testing Update 6/24/2014 Expanded Testing Update
Partner Services Presentation 5/01/2014 Partner Services Presentation

Monitoring Standards as of 4/2013

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  • Part A Fiscal Monitoring Standards
  • Part A Program Monitoring Standards
  • Part A & B Universal Monitoring Standards
  • Part A & B Monitoring Standard FAQs

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Tools for Prevention Providers

Templates

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CY 2015 Prevention Program Guidance as of 3/13/2015

Prevention Program Guidance

Prevention Site Visit Tools as of 01/26/17

Prevention Site Visit Tool

Prevention Site Visit Tools Changes Cheat Sheet 1/26/17

Cheat Sheet

Changes in use of HE/RR and GSAQ Forms as of 1/09/2014

HE/RR and GSAQ

Prevention Biannual Narrative Report Template as of 06/28/17

Prevention Biannual Narrative Report Template

Prevention Materials Review Protocol as of 11/8/2010

Prevention Materials Review Protocol (PDF)

Prevention Materials Review Request Form as of 1/20/2016

Prevention Materials Request Form (fillable Word doc)

LEO Information and Forms

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LEO Data Entry Guide for Verified Medical Visits and Referrals LEO Guide
LEO Partner Information Form (PIF) effective 1/01/2015 LEO Partner Information
Completing LEO Partner Information Form (PIF) Instructions Completing PIF
PIF instructions
LEO Self Administered Questionnaire effective 7/01/2014 LEO Self Administered Questionnaire
Risk Reduction Activities Form effective 7/01/2014 Risk Reductions Activities Form
LEO Data Quality Tips 2016 as of 06/03/16 Risk Reductions Activities Form
LEO Data Quality Tips 2015 LEO Data Quality Tip Archived
LEO Data Quality Tips 2014 LEO Data Quality Tip Archived

Tools for HIV Testing Providers

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HIV Testing Procedures and Quality Assurance Plan Template as of 5/07/15
HIV Testing Biannual Report Template as of 06/28/17 HIV Testing Biannual Report Template
HIV Counseling Information Form as of 7/2012 HIV Counseling Form
Client Assessment Questionnaire effective 7/01/2014 Counseling and Testing
HIV Test Kit Competency Checklist as of 11/2013 HIV Test Kit Checklist

Tools for Quality Management

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Quality Management Plan Checklist as of 3/21/2006 QM Plan Checklist
Quality Management Plan Template for Care Services as of 11/12/2013 QM Plan Template-Excel File

Quality Management Plans, Reports, and Indicators

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FY16 Quality Management Report Template as of 2/11/2016

Prevention QM Template

FY15 HIV Planning and Coordination Quality Management Plan as of 10/05/2015

HIV PAC QM Plan

FY15 Quality Management Performance Measures as of 10/05/2015

HIV PAC QM Plan

FY14 Quality Management Outcomes Summary Report as of 10/05/2015

HIV PAC QM Plan

FY14 Care Services Quality Indicators as of 11/05/2014

FY14 Care Svcs QI

FY14 Prevention Services Quality Indicators as of 6/19/2014

FY14 Prevention Svcs QI

In+Care Reports

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In+Care Reports 2016

In+Care Report

In+Care Reports 2015

In+Care Report

In+Care Reports 2014

In+Care Report

HRSA Policy Notices

HRSA Policy Notices are located here

Ryan White Services Standards of Care

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Case Management Standards of Care as of 04/13/16

Case Management Standards of Care for Ryan White Act-Funded Services in Orange County - Adobe Acrobat version

Common Standards of Care as of 3/01/2014

Common Standards of Care for Ryan White Act-Funded Services in Orange County - Adobe Acrobat version
Legal Standards of Care as of 02/2016

Common Standards of Care for Ryan White Act-Funded Services in Orange County - Adobe Acrobat version

Oral Health Standards of Care as of 3/02/2015

Common Standards of Care for Ryan White Act-Funded Services in Orange County - Adobe Acrobat version

Outpatient/Ambulatory Medical Care Standards of Care as of 3/01/2013

Common Standards of Care for Ryan White Act-Funded Services in Orange County - Adobe Acrobat version

Nutrition Services Standards of Care as of 7/08/2015

Nutrition Standards of Care for Ryan White Act-Funded Services in Orange County - Adobe Acrobat version

Medical Transportation Standards of Care as of 6/14/2010

Medical Transportation Standards of Care for Ryan White Act-Funded Services in Orange County - Adobe Acrobat version

Mental Health Standards of Care as of 04/13/2016

Mental Health Standards of Care for Ryan White Act-Funded Services in Orange County - Adobe Acrobat version

Substance Abuse Services Standards of Care as of 12/09/2015

Mental Health Standards of Care for Ryan White Act-Funded Services in Orange County - Adobe Acrobat version

Ryan White Part A Manual

Ryan White Part A Manual

HIV Services Quarterly Narrative Report Template