You may submit a request for any of the following records in accordance with applicable public records laws. The departments have included a direct link to some of the records; if there is no link for the record you are seeking, and/or you would like to request additional information regarding that record, please contact the department or division directly using the contact information provided for that specific record.

Absence Request (Staff)
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
1 Year
Acknowledgment For Providers of Request For Inspection
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Acknowledgment of Dependent Adult/Elder Abuse Reporting Requirement
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Acknowledgment of Request For Copies Request For Payment
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Administration Activity Slip Patient Related
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Admission Tracking Form
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Affidavit of Custodian of Medical Records
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Agreement For Improving Expediting Services
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
5 yrs
Appeal Form For Adults-Target Population Criteria
Category:
Administrative Records
Remarks:
Dept. Policy
Division:
Mental Health
Retention Type:
1 - Permanent
Retained On-Site:
Indefinitely
Appeal Form For Services Denied to Adults/Older Adults
Category:
Administrative Records
Remarks:
Dept. Policy
Division:
Mental Health
Retention Type:
1 - Permanent
Retained On-Site:
Indefinitely
Application For Dmstraining Funds
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
1 Year
Atypical Neuroleptics Request Form
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
3 yrs
Certification of Disability
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
5 yrs
Certification of Record Destruction
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Client Payment Transmittal
Category:
Administrative Records
Remarks:
Department. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Client Registration Form
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Client Registration Log
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Client Satisfaction Survey
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Cmhs Billing Slips (All Providers)
Category:
Administrative Records
Remarks:
Department. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Cmhs Monitoring Report Findings
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 years
Retained Off-Site:
3 years
Denial of Access/Detrimental Effect On Relationship (Minor)
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Dms Formulary Change Form
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
3 yrs
Documentation of Health Plan's Denial of Coverage
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 Yrs
Employee Records
Category:
Administrative Records
Remarks:
Tittle 22
Division:
Mental Health
Retention Type:
1 - Permanent
Facility Bill
Category:
Administrative Records
Remarks:
Department. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Forms Order
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
1 Year
Good Cause Certification Submit Medicare
Category:
Administrative Records
Remarks:
Department. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Grievance Form-(English/Spanish/Chinese)
Category:
Administrative Records
Remarks:
Department. Policy
Division:
Mental Health
Retention Type:
1 - Permanent
Retained On-Site:
Indefinitely
Informed Consent For Participation as A Research Subject
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 years
Retained Off-Site:
3 years
Inpatient Plant Checklist
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Involuntary Detention Log
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
1 Year
Involuntary Patientadvisement
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Justification and Recommendation For Conservatorship
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Letter Notifying Parties/Court of Intention to Raise Objections to Disclosure
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Letter to Attorney -Notification of Need For Court Order
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Medi-Cal Eligibility Form
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Medicare, All Other Insurance Bills and Claims
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 years
Medication and Supply Order Form
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
3 yrs
Mental Health Facility 24 Hr-Care Daily Census Report
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Mental Health Provider Data Form-Cover Sheet
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Monitoring Report Summary
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 years
Retained Off-Site:
3 years
Monitoring Report Summary Provider Administration
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 years
Retained Off-Site:
3 years
Monitoring Report Summary-Program Operation
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 years
Retained Off-Site:
3 years
Movement Tracking Form
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Notice of Action Denial of Access to Medical Records
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Notice of Action Termor Reduction of Services
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Notice of CertificatioNSF County
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Notice to Mental Health Providers of Necessity to Reviewing /Redacting Subpoenaed Mental Health Record
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Notification of Alternative to Review Mental Health Record
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Notification of Provision of Summary Alternative
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Notification That Minor Patient's Right of Inspection Lies Elsewhere
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Notification to Licensed Professional Named as Alternative to Review Medical Records
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Notification to Patient of Denial of Access to Medical Records
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Notification Toparent/Guardian Right to Inspection Lies Elsewhere
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Oath of Confidentiality (Staff)
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Oath of Confidentiality For Research
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Office of the Day Log (Od)
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Outpatient Servicestime Report Form - Adult
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Outpatient Servicestime Report-Child
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Parent Satisfaction Survey
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Patient's Consent to Disclosure of Medical Records and Waiver of Evidentiary Privileges
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Provider Data Form
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
1 Year
Quality Improvement Response Report
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Quality Management Inpatient Reference Sheet
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Quality Management Review Inpatient Notice of Concern
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Quality Management Review Inpatient Quality Review
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Quality Management Review Outpatient Notice of Concern
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Quality Management Review Outpatient Quality Review
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Quality Management Review Outpatient Reference Sheet
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Quality Review Inpatient Chart Worksheet
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Quality Review Outpatient Chart. Worksheet
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Registered Bed Continued Stay Report Sheet
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Request For Accessmedical Records
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Request For Information Cover Letter
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Request Log
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Research Committee For the Division of Mental Health and Substance Abuse Minutes and Documents
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
5 yrs
Response to Request For Information
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Sample Order For Production of Mental Health Records
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
7 yrs
Sf Dms Child/Adolescent and Referral/Request For Shadow Services
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
2 yrs
Site Survey Form
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
Staff Information Form
Category:
Administrative Records
Remarks:
Administrative Decision
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
5 yrs
Transfer/Admission Screening Checklist
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs
UR Committee Minutes
Category:
Administrative Records
Remarks:
Legal Ret. Dept. Policy
Division:
Mental Health
Retention Type:
2 - Current
Retained On-Site:
4 yrs