You will need to pay the fee or submit a Request to Waive Court Fees. All Forms Assessor Forms Recorder Forms County Clerk Forms All Assessor-Recorder-Clerk Forms Show entries Search: Showing 1 to 10 of 147 entries Previous Vice Chairman/Supervisor First District Jesse Armendarez For graffiti abatement, call 1.877.442.2283. f Consolidation of Electronic Signature (E-Signature). To submit a form via email, users must first download the form to their device and then click "submit" on the completed form. DCS 125 CPS (7/04) Author: L1634 Adult Protective Services; . Health and Human Services Public Safety and Justice Community Services Recreation and Culture Government Services Board of Supervisors Col. Paul Cook (Ret.) 2. 0.749023 g The reporter's identity is confidential, but a name should be given so the Department could follow-up contact with the reporter if necessary. provides an avenue for reporting fraud, waste, and abuse within SSA's programs and operations. 21 0 obj <> endobj Two-year-old Isaac Lethbridge died on August 16, 2006 because Child Protective Services social workers took him from his parents and placed him in an unsafe foster home environment. Website Services. 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 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. 2023 San Bernardino County | . 123 0 obj <>/Filter/FlateDecode/ID[<4E5FEE2E7615B60FE59503200306F587>]/Index[21 218]/Info 20 0 R/Length 225/Prev 152285/Root 22 0 R/Size 239/Type/XRef/W[1 2 1]>>stream There are no geographic restrictions. H237402VH2P0P To Report Child Abuse. endstream endobj 38 0 obj <>/Subtype/Form/Type/XObject>>stream Thank you for the opportunity to assist you! Office Configuration Safety Standards (12/18/2018) New! Welcome to San Bernardino County America's largest county. 909-484-7667. 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. H237402VH2P0P037U03U(JJ*2T0T0BC#S\.1* e 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. f Easily fill out PDF blank, edit, and sign them. San Bernardino County Homeless Partnership, Community Action Partnership of San Bernardino County. 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. of Industrial Relations web site. 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. COVID-19: COURT OPERATIONS DURING THE COVID-19 PANDEMICRevised 5/2/2022 - 9:32 am. ENGLISH SPANISH Please be advised that incomplete or inaccurate information may delay the processing of your request. Contact Us Visit Website View Profile. The Child Protective Services goal is to keep the child in his/her own home when it is safe, and when the child is at risk, to develop an alternate plan as quickly as possible. III. 11118 Elm Avenue, Rancho Cucamonga, CA 91730. endstream endobj 22 0 obj <> endobj 23 0 obj <> endobj 24 0 obj <> endobj 25 0 obj <>/Subtype/Form/Type/XObject>>stream These 24-hour Hotlines are staffed by trained social workers. Resource Parents are often called upon to provide information to the child protective services worker, as well as to testify in court. 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 Below are a few helpful hints on how to navigate . 1586 0 obj <>stream Services are provided in person, by phone, online, and by email. `AS`8W!L$T1R1!PE b@. T hb```e``0i% X8 99p0P0]3 D+Zd NU*0C!UC endstream endobj 52 0 obj <>/Subtype/Form/Type/XObject>>stream f`a3p8WDT!"kg```P5Bsr Application for Services Forms Application for Child Support Services E\\y\FAS\.BB1X!S` 1 To speak to someone about behavioral health services, call 888.743.1478. Child Abuse Reporting Policy: 05/13/2021 CHD0303 Child Abuse Reporting Procedure . Address 150 S. Lena Rd. endstream endobj 46 0 obj <>/Subtype/Form/Type/XObject>>stream Forms & Fees - San Bernardino County Assessor-Recorder-Clerk Forms & Fees Fees for all Assessor services Fees for all Recorder and County Clerk services For the Recorder fee calculator click here. H237402VH2P0P007 Report by phone: (877) 605-2321. http://www.childsworld.ca.gov/res/pdf/CPSEmergNumbers.pdf. Find substance use disorders and/or alcohol recovery services? Child Abuse Hotline for San Bernardino County is. To Report Child Abuse San Bernardino County residents can dial 2-1-1 to anonymously report if they suspect a child is being abused. can be found on the State of California's, Department 0.749023 g endstream endobj startxref . Get the free san bernardino county children and family form cfs 125 cps 2014-2022. . Phone : 909.384.9233 Phone : 800.827.8724 Code Enforcement Hotline The Code Enforcement Division of the Land Use Services Department receives complaints regarding land use, zoning, housing, public nuisances, vehicle abatement, and vegetation or fire hazard abatement. f Revised Child/Adolescent Psychiatric Evaluation CLP014, Regulations Regarding Welfare and Institutions Code WIC, CLP015-1 Child/Adolescent Assessment-CANS-SB 05/02/2017, Implementation of the Diagnostic and Statistical Manual, Medicaid Managed Care Final Rule Implementation, Confidentiality Statement Requirement for Safeguarding, Implementation of Title Change of Marriage and Family, Psychiatric Mental Health Nurse Practitioners, New Mental Health Procedure Codes (10/13/2016), Outpatient Chart Manual and Scope of Practice Guide, Revised Medicare Certification Requirement (01/29/2016), Electronic Mail (e-mail) Encryption (11/19/2015), Contact by Outside State or Federal Agencies, Breining Institute Accreditation Termination, Updates to the Scope of Practice and Billing Guide, Updated DBH Billing Forms and Reference Materials, Medi-Cal Expansion-Determining Tier III Service, ICD-10 Implementation Delayed (04/03/2014), Medicare Updates Regarding ICD-10 (02/20/2014), Updates to the Lanterman-Petris-Short (LPS) Act, Diagnostic and Statistical Manual of Mental Disorder, Discontinuance of Procedure Code 365 (11/05/2015), Non-use of Blood Glucometers (06/02/2015), Marriage and Family Therapist Intern Experience, Board of Behavioral Sciences (BBS) Amendments, Care Necessity Form Revision (09/13/2013), Medicare Administrative Contract Transition 07/15/2013, Mental Health Plan (MHP) Contract Clarifications, Client Index Number (CIN) Policy Enforcement 07/02/2013, Accreditation of Certifying Organizations (04/30/2013), Changes in Charge Data Invoice (CDI) Codes (12/27/2012), Outpatient Chart Manual/Initial Contact Form 12/20/2012, License Denied or Suspended for Failure to Pay Taxes, Requirements for Lactation Accommodations (01/06/2012), Board Referral of Matters to County Staff (10/26/2011), Authorization of Release of Protected Health Info, Sharing of Protected Health Information relating to MH, Medi-Cal Claims Processing Requirements When Other, Scope of Practice and Billing Guide (05/17/2011), Updates to Universal Chart Data Invoice (CDI) Codes, Outpatient Chart Manual (OCM) Revision (05/09/2011), Medi-Cal Eligibility System (MEDS) (01/18/2011), Sanctions for Certification of Excluded, Suspended, Adhering to Educational Regulations (05/26/2010), Providing Written Communication to Consumers/Family, Medicare: Forms Update u0026amp; Review Process (03/01/2010), Certification of Alcohol and Other Drug (AOD) Counselor, Simon Update for Short Doyle/Medi-Cal Phase II, Approval of Promotional, Educational and/or Information, Referral of Clients from Contract Agencies, Health Family SED Services Policy/Procedures 02/11/2009, Outpatient Chart Manual (OCM) Changes (01/26/2009), Inpatient Claims for Medi-Cal Recipients with other, Deficit Reduction Act Compliance (11/24/2008), Incentive Cards Procedure and Controls (12/10/2007), CDPH Orders for Behavioral Health Facilities u0026amp; Workers, Flexibilities for Medicare Telehealth Services, Chart Entry to Address Provider Professional Credentials, New Timeframes for Completion of Progress Notes, myAvatar Chart Documentation Procedural Changes (IIN 21-002), Network Adequacy Certification Tool (NACT) (07/01/2020). The Adult Protective Services (APS) program is mandated by the State of California. Try it now! ,&?(bYY Vb4*LgPr`2GH X, 9974|3/ Wy8L@O q][Wk9URk#w+mr5A! SAN BERNARDINO COUNTY CHILD AND FAMILY SERVICES - CHILD PROTECTIVE SERVICES The program provides child protective services for San Bernardino County. County Operator General County Information Telephone: Toll Free (888) . If you do not see the form you need, please check if it can be ordered through the Children's Medical Services Catalog or contact us and we will try to accommodate your request.. endstream endobj 37 0 obj <>/Subtype/Form/Type/XObject>>stream You may be trying to access this site from a secured browser on the server. Box 1359 Susanville, CA 96130-1359 Website Lassen County Health & Social Services Agency Ms. Barbara Longo, Director P.O. California Children's Services Forms. 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. H237402VH2P0P037U03U(JJ*2T0T0BC#S\.1* e Child Support Process Understanding Child Support DCSS Services Step-by-Step Process for Child Support Child Support Process Forms Save or instantly send your ready documents. endstream endobj 34 0 obj <>/Subtype/Form/Type/XObject>>stream 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. . 0.749023 g Information on how to report child abuse or make complaints. Forms & Publications . Use professional pre-built templates to fill in and sign documents online faster. 1. endstream endobj 42 0 obj <>/Subtype/Form/Type/XObject>>stream E\i\\ Follow the installation instructions on Adobe's web site to properly install and configure the Acrobat Reader. f 2\`q#=csS&c. f It looks like your browser does not have JavaScript enabled. Mental Health and Alcohol and Drug Services Agency Evaluation, Timely Access Notice (NOABD) (Vietnamese), Mental Health Plan (MHP) to Medi-Cal Plan (MCP) Referral Form For Non Open Cases, Financial Liability Notice (NOABD) (Spanish), Financial Liability Notice (NOABD) (Mandarin), Financial Liability Notice (NOABD) (Vietnamese), myAvatar Program Assignment (Mental Health), myAvatar Program Assignment (Mental Health)(Spanish), myAvatar Initial Contact Form (Mental Health, myAvatar Initial Contact Form (Mental Health) (Spanish), Authorization to Release Protected Health Information (PHI), Authorization to Release Protected Health Information (PHI) (Spanish), Authorization to Release Protected Health Information (PHI) (Vietnamese), Code of Conduct and Code of Conduct Acknowledgement, Notice of Privacy Practices and Acknowledgement of Receipt of Notice of Privacy Practices, Certification Review Hearing Waiver of Presence, Outpatient Treatment Reauthorization Request for Adults, List of Disclosures of Protected Health Information (PHI), Consent for Outpatient Treatment (Spanish), Consent for Outpatient Treatment (Vietnamese), Medical Care Authorization for Minor (Spanish), Consent for Sound and/or Photographic Recordings, Consent for Sound and/or Photographic Recordings (Spanish), Consent to Record and/or Photograph and Authorization for Use or Disclosure, Consent to Record and/or Photograph and Authorization for Use or Disclosure (Spanish), Conflict of Interest Disclosure Statement, Access to Medical Records Request (Spanish), Response to Request to Access Medical Records, Response to Request to Access Medical Records (Spanish), Request to Amend Protected Health Information (PHI), Request Request to Amend Protected Health Information (PHI) (Spanish), Response to Request to Amend Protected Health Information (PHI), Response to Request to Amend Protected Health Information (PHI) (Spanish), Internal Tracking of Request to Access Medical Records, Release of Information: Patients Right of Access to His/Her Own Medical Record, Release of Information: Patients Right of Access to His/Her Own Medical Record (Spanish), Advance Health Care Directive (Brochure) (Spanish), Advance Health Care Directive (Brochure) (Vietnamese), Privacy and Security Agreement Confidentiality Statement, Ineligible Persons Policy Acknowledgement and Attestation, Attestation Regarding Completion of Sanction Checks, Electronic Signature Agreement and E-Signature and Provider Signature List, DBH & BBS Complaint Notifications to Clients (8-20), DBH & BBS Complaint Notifications to Clients (8-20) (Spanish), myAvatar Policy/Procedure Acknowledgement Form, Patients Rights Grievance Form (Spanish), Patients Rights Office Grievance Appeal Form, Patients Rights Office Grievance Appeal Form (Spanish), Request for Restriction of Confidential Communication, Request for Restriction of Confidential Communication (Spanish), Response to Request for Restriction of Confidential Information, Response to Request for Restriction of Confidential Information (Spanish), Grievance and Appeal Timely Resolution Notice, Grievance and Appeal Timely Resolution Notice (Spanish), Adult (21+) ASAM Triage Level of Care Screening, Consent for SUD Care Coordination Services (English), Termination of Provider Notice Template_Spanish, Receipt of Grievance Acknowledgement Letter, Receipt of Grievance Acknowledgement Letter (Spanish), Grievance Investigation Supplemental Response Form, Pre-Licensed/Out-of-State Licensed Psychologists Statement of Awareness for Continued Employment, Non-Medication Resource Log and Instructions, Emotional Support Animal Clinical Documentation Policy, DMC-ODS Requirements for period 2022-2026, Documentation Requirements for all SMHS DMC and DMC-ODS Services, Clinical Supervision for Pre-Licensed Psychologists, Request to Change the DBH Websites Policy (BOP3047), Request to Change the DBH Websites Procedure (BOP3047-1), Adult System of Care, Intensive and Aggressive Case Management, and ACSP Coordinated Services, Reporting Dependent Adult/Elder Abuse and Neglect Policy, Reporting Dependent Adult/Elder Abuse Procedure, Adult System of Care Out-of-County Placement Policy, DBH Alcohol and Other Drug (AOD) Programs Counselor Certification Policy, Alcohol and Drug Services Code of Professional Conduct Policy, Medication Policy for Clients Seeking Alcohol and Drug Treatment Services, Alcohol and Drug Services (ADS) Youth Treatment Policy, Alcohol and Drug Services (ADS) Perinatal Treatment Policy, Admission Preference and Interim Services Policy, Admission Preference and Interim Services Procedure, Expenditure of the Substance Abuse Prevention and Treatment Block Grant Policy, Substance Use Disorder Medication Safety and Effectiveness Policy, Substance Use Disorder Service Utilization Policy, Substance Use Disorder and Recovery Services Coordination of Care Policy, Substance Use Disorder and Recovery Services Coordination of Care Procedure, Post Client Satisfaction Survey Procedure, Substance Use Disorder and Recovery Services Residential Prior Authorization Policy, Case Management Services for Child and Adolescent Clients, Providing Services to Foster Care, Adoption Assistance Program (AAP) and Kinship Guardianship Assistance Payment (KinGAP) Children Placed Out-of County Policy, Providing Services to Foster Care Children Placed Out-of-County Procedure, Providing Services to Adoption Assistance Program (AAP) and Kinship Guardianship Assistance Payment (KinGAP) Children Placed Out-of County Procedure, Childrens Fund Immediate Need Voucher Policy, Childrens Fund Immediate Need Voucher Procedure, Consent to Treat a Minor: Procedures for Parents/Legal Guardians, Consent to Treat a Dependent Minor Procedure, Clinic Responsibility for Processing Client Registration, PFI, CDI, Charge Data Invoice (CDI) Process Procedure, Treatment of DBH Employees by DBH Facilities, Acknowledgement of Abuse Reporting Duties Policy, Clinical Supervision for Licensure AMFT, ACSW, APCC, Admission Standards for Penal Code Misdemeanor Violations, Out-of-County Access for Mental Health Services, Waiver of Consumers Responsibility to Pay for Medications, Authorization and Designation Pursuant to the Lanterman-Petris-Short (LPS) Act, Duty to Warn and Protect Third Parties in, Duty to Warn and Protect Third Parties in Response to a Client Threat (Tarasoff) Procedure, Day Treatment Weekly Charting in Staff Meetings, Confidentiality When Dealing with Client Support Persons, Clients with Physical Medical Conditions Policy, Transformational Collaborative Outcomes Management (TCOM) Policy, Transformational Collaborative Outcomes Management (TCOM) Procedure, Client Notice Regarding Termination of Provider Procedure, Sending Confidential Information by Facsimile, Medical Record Security Policy for Outpatient Services, Confidentiality of Protected Health Information (PHI), Unauthorized Access of Confidential Medical Records, Medical Records Requiring Special Handling, Medical Records Requiring Special Handling Procedure, HIPAA Notice of Privacy Practices (NOPP) Policy, Authorization to Release Protected Health Information (PHI) Procedure, Trafficking Victims Protection Act of 2000, Compliance Verification, Monitoring and Auditing Policy, Security of Protected Electronic Health Information Policy, Access and Amendment of Medical Records Policy, Patients Rights Inpatient Grievance Process, Patients Rights Outpatient Grievance Process, HIPAA National Provider Identifier (NPI) Policy, HIPAA National Provider Identifier (NPI) Procedure, Right to Request Alternative Means of Communication Protected Health Information Policy, Medi-Cal Eligibility Data Systems (MEDS) Policy, Transportation of Protected Health Information (PHI) Policy, Transportation of Protected Health Information (PHI) Procedure, Non-Discrimination of Clients (Affordable Care Act) Policy (COM0953) Rev. Request for Second Opinion QM048_E Revised! Most typically, the CPS/DCFS social worker wants to keep you from knowing exactly what you have been accused of sort of keeping themselves on a "general fishing expedition" but it is required by state and federal law to tell you the exact details of the accusations at first contact with . WHITE COPY-Police or Sheriff's Department; BLUE COPY-County Welfare or Probation Department; GREEN COPY-District Attorney's Office; YELLOW COPY-Reporting Party SS 8572 (12/02) Page 2 of 2 Title of Industrial Relations web site. Give your local county office your updated contact information so you can stay enrolled. *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). If you feel you have a claim against the County, we encourage you to first attempt Get access to thousands of forms. Change of Provider Request Form - 18pt. endstream endobj 53 0 obj <>/Subtype/Form/Type/XObject>>stream %PDF-1.7 % 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. 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. endstream endobj 36 0 obj <>/Subtype/Form/Type/XObject>>stream California Family and Domestic Violence Referral Directory. Mental Health Consumer Perception Survey-Fall 2019 New! hbbd```b``" 0i"H`s.8C>nf"Ynu8X8=L?jd &7$+: ,"y3L`qQr&):w4"3p vkJ4 Registration process. Who live or work in San Bernardino County, Through San Bernardino County Homeless Veterans Initiative. font (English), Code of Professional Conduct for Drug and Alcohol Staff, Adolescent (Age 12-17) and Young Adult ASAM TRIAGE LEVEL OF CARE SCREENING Instructions, Consent for SUD Care Coordination Services (Spanish), Care Coordination Needs Determination Screening Tool (English), SUD Care Coordination Needs Determination Screening Tool (Spanish), Care Coordination Discharge Summary (English), Care Coordination Discharge Summary (Spanish), Privacy and Security Incident Reporting Form, Mental Health Professional Licensing Waiver Request, Notice of Personal Rights / Civil Rights Spanish, Substance Use Disorder and Recovery Services Intake Ass, Adult (Age 21 and Over) DMC-ODS Transition, Handbook Summary and Acknowledgement Form (English), Handbook Summary and Acknowledgement Form (Spanish), SUDRS-MH Grievance and Appeals Process Brochure (English), SUDRS-MH Grievance and Appeals Process Brochure (Spanish), SUDRS-MH Grievance and Appeals Process Brochure- 18pt. endstream endobj 54 0 obj <>/Subtype/Form/Type/XObject>>stream Child Welfare Services Child Abuse Hotline Child Abuse Hotline For more information, or to report suspected child abuse, call 858-560-2191. San Bernardino County residents can dial. File a USDA program discrimination complaint? To file a claim against the County please complete the form below, print, sign and Child and Family Teams (CFTs) During this state of emergency related to the Novel Coronavirus (COVID-19), the CFT process serves as an essential strategy to ensure families and providers can continue caring for children and that the county is aware of the practical and emotional needs of caregivers and children. 0 0 6.75 7.5 re Please enable scripts and reload this page. Find your local county office. The San Bernardino County Department of Child Support Services determines paternity, establishes and enforces child support orders, and secures payments to assist the financial and medical needs of their children. In cases of an immediate emergency, always call 9-1-1 for Law Enforcement intervention. The following are forms for the California Children's Services Program.. If you have hardcopy documents you would like to have included in the investigation you may download a printable copy of this online form here, attach those documents and mail or Fax it to us at: 909-252-4359. 0 0 8.25 9 re 2r\.1K 7 H237402VH2P0P32UT(JJ*2T0T0D|[email protected]! % Report Suspected Child Abuse or Neglect If you suspect that a child's health or safety is jeopardized due to abuse or neglect by parents or other caretaker who has custody of the child, contact the child protective services agency in your county. You do not need to mail the original. Call (833) 526-5197 to schedule a consultation to get your immediate questions answered and get the legal representation you need. To see if you will need any special, local forms, contact your court clerk or check your court's website. cps report form san bernardino county. Fraud, Waste, and Abuse Hotline 800.547.9540. H*2T0T03Tp. H237402VH2P0P0342E\i\\ hAAgpBE TN= 3j:)iZ#Y:TV@[F^KA `Gs'1?4Tyk'us*"Oz~~WP6W3=BA!>vHh &kd4:[FO] lA Take a look back at San Bernardino Countys major accomplishments in 2022, Homeless to Home, a road to self-sufficiency. This year, San Bernardino County settled a lawsuit for $7.5 million in a case that alleged that a county social worker was aware of sexual abuse in the foster care system and failed to report it. Col. Paul Cook (Ret. when an social worker,caseworker at CPS has clearly undermine her family for 8 years & others. endstream endobj 48 0 obj <>/Subtype/Form/Type/XObject>>stream Americas largest county. If you are struggling with a juvenile matter involving CFS in San Bernardino or CPS in Riverside, The Haynes Law Firm, APLC is available to provide a consultation regarding your case. f 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). endstream endobj 51 0 obj <>/Subtype/Form/Type/XObject>>stream Preschool services feeds meals to children. . %%EOF Step 2: Fill out your forms completely. 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