LA County Department of Public Health - Substance Abuse Prevention and Control - Provider Manual and Forms

Translate

A-Z Index

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z ALL

Font Size | A A A

LA County

Substance Abuse
Prevention and Control

Substance Abuse Prevention and Control

Methamphetamine Dashboard: Tracking Patterns in Methamphetamine Use Network Adequacy Certification Important FAQs About Vaping Data Reports and Briefs Commission on Alcohol and Other Drugs Safe Med LA Safe Medication Disposal Opioid Abuse Prevention and Treatment in Los Angeles County Fact Sheet Provider Advisory Committee (PAC) Prescription Medication Misuse and Public Perceptions in Los Angeles County: Findings from the 2017 Community Needs Assessment Prop. 64 and Responsible Adult Use of Marijuana

PROVIDER INFORMATION AND
SAPC PROGRAM RESOURCES

UPCOMING PROVIDER TRAININGS, CONFERENCES, AND IMPORTANT EVENTS

Provider Manual and Forms

Provider Manual for Substance Use Disorder Treatment Services Version 7.0 (Updated - September 2022)
Quick Reference Guide - Changes to the Provider Manual Version 7.0 (Updated - September 2022)
Patient Handbook (English) (New - March 2023)
Patient Handbook (Spanish) (New - March 2023)
Patient Handbook (English - Large Print) (New - March 2023)
ASAM Levels of Care and Dimensions: Youth and Adults
Patient/Provider Orientation Videos for Substance Use Disorder Treatment System of Care
Overdose Bag Kit and Instructions Guide Materials
Certified Peer Support Specialist Program (New)

CENS Standards and Practice

Clinical Forms and Documents - Treatment Services Related

ASAM Assessment Requirements (Updated - March 2023)
ASAM CONTINUUM to SAPC Level of Care Crosswalk
Assessment Instructions - Adults
Assessment Tool - Adults (Paper Version)
Assessment Instructions - Youth
Assessment Tool - Youth (Paper Version)
Checklist of Required Documentation for Utilization Management
- Sage Version 5.0 (Updated - March 2023)
Eligibility Verification and Member Authorizations (Updated - December 2021)
Document Examples within the Specialty Substance Use Disorder (SUD) System
Drug Testing Form
DSM-5 Substance Use Diagnosis
Housing Resources
Notice of Privacy Practices (English)
Notice of Privacy Practices (Spanish)
Patient Handbook and Orientation Video Acknowledgment Form
For more languages, click here
Patient Handbook Summary and Distribution Verification Form
Problem List-Main
Problem List Addendum (Additional Problems)
Release of Information - In SAPC SUD Provider Network (Updated - September 2021)
Release of Information - Outside SAPC SUD Provider Network (Updated - July 2020)
Screening - Adults (Paper Version)
Screening - Parents for Youth (Paper Version)
ASAM Screener for Youth and Young Adults (New - October 2022)
Special Population forms:
- DPSS-CalWORKs:
- DPSS-General Relief:
  - Treatment Provider Report of Changes
Treatment Plan
Treatment Plan Addendum

Clinical Forms and Documents - Administrative and Quality Improvement Related

Adverse Event Reporting Form
Appeal Form
Complaint and Grievance Form
Complaint and Grievance Form - Spanish
Notice of Adverse Benefit Determination Forms
Discharge and Transfer Form - All Levels of Care (Except RBH)
Interested in Becoming a SAPC Contracted Provider?
Progress Note Template
Recovery Bridge Housing Authorization Request Form
Recovery Bridge Housing Discharge Form
Reportable Incident Reporting Form

Contract Related Forms and Documents

Our Prospective DMC Contract Application is currently being revised. Please contact SAPCmonitoring@ph.lacounty.gov should you have any question.
Application for Opioid Treatment Program License 12-1-19
Field Based Narrative Instructions
Field Based Service Work Plan Summary
SAPC Contractor Corrective Action Plan Form

Finance Related Forms and Documents

Interpreting the Real Time 270 Results
- Interpreting the Real Time 270 Results Presentation
Correcting Diagnosis Errors in Sage
Documenting Changes in Financial Eligibility Status (Updated - August 2022)
- Updating Financial Eligibility for Patients Who Obtain Benefits During Treatment (Updated - August 2022)
- Updating Financial Eligibility for Patients Whose Benefits Expired During Treatment (Updated - August 2022)
- Updating Financial Eligibility Admitted Under Other County Funding or MHLA (Updated - August 2022)
- Updating Financial Eligibility for Self-Pay Patients Who Establish Benefits (Updated - August 2022)
Claiming for SUD Screening Instructions (Updated – February 2023)
Claim Denial Reason and Resolution Crosswalk for Providers (Updated - May 2021)
Denial Crosswalk Instructions Version 3.0 (Updated - May 2021)
Quick Guide to Identifying Denials
Cost Report Forms and Instructions
Treatment Rates and Standards Matrix (Updated - September 2021)
DMC-ODS Budget Narrative
DMC-ODS Budget Summary
Budget Narrative Revised
Budget Summary Revised
ICD-10 & DSM-5 Crosswalk

Information Technology (IT) Related and Documents

Critical Error Report Guide for 837 Files
Inbound 837 File Naming Conventions
Reupload File (277, 835, EOB, RA) Request Form
Sage Attachment Naming Convention (Updated - February 2022)
SBAT Survey Webinar 2018/19
SBAT User Registration Form
Service and Bed Availability (SBAT) User Guide
SBAT Training Video: New Intake Availability Functions
SBAT Training Video: Availability Dashboard
SBAT Training Slides: Availability Dashboard
SBAT Training: Availability Dashboard Q&A
Companion Guide HIPAA 837
Companion Guide HIPAA 837I (Updated - May 2020)
Data Collection User Guide LACPRS/CalOMS Tx
Sage Sample LACPRS/CalOMS Data File (Right-click and select "Save target as..." to download the file)

Email: Webmaster |

Notice of Privacy Practices |

Website Privacy Policy |

Accessibility |


Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.