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. For your convenience, virtual interviews are available. Children and Family Services (CFS) is a department within San Bernardino County dedicated to protecting and promoting the well-being of abused, neglected or exploited children in our county. 2: Ask what the accusations and charges are. The San Bernardino County District Attorney's Office serves the residents, business owners, and visitors of San Bernardino County, California. Please turn on JavaScript and try again. endstream endobj 29 0 obj <>/Subtype/Form/Type/XObject>>stream Tell us what you think about the new website. A hotline for impacted residents is open from Monday through Friday, 8 a.m. to 7 p.m. at (909) 356-2563. Step 2: Fill out your forms completely. f Use Arrears calculator to figure out balance. for appropriate follow-up and related document completion. 0.749023 g Child Abuse Reporting Policy: 05/13/2021 CHD0303 Child Abuse Reporting Procedure . Request for Second Opinion (Spanish) QM048_S Revised! H237402VH2P0P037U03U(JJ*2T0T0BC#S\.1* e Our job is to create a county in which those who reside and invest can prosper and achieve well-being. Who should report allegations of abuse or neglect? E\i\\ 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. `Sp8WrU B 0 k The California Public Records Act is found in the California Government Code, beginning at Section 6250. To see if you will need any special, local forms, contact your court clerk or check your court's website. http://www.childsworld.ca.gov/res/pdf/CPSEmergNumbers.pdf. 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. 2r\.1K 7 I am an older adult and need help taking care of myself. San Bernardino, CA 92415. 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. E\\y\Fz0\.S=3H!C 9 endstream endobj 44 0 obj <>/Subtype/Form/Type/XObject>>stream Request for Second Opinion QM048_E Revised! endstream endobj 53 0 obj <>/Subtype/Form/Type/XObject>>stream Forms & Publications . endstream endobj 28 0 obj <>/Subtype/Form/Type/XObject>>stream COVID-19: COURT OPERATIONS DURING THE COVID-19 PANDEMICRevised 5/2/2022 - 9:32 am. 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. 2. This form documents the information given by the reporting party on the suspected incident of abuse or neglect of an elder or dependent adult. Registration process. CFS does not supply these forms. Child Protective Services. 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. 909-484-7667. Disaster Response Requirements (02/01/2017) New! Vice Chairman/Supervisor First District Jesse Armendarez H*2T0T0 f 2. Missing payments increase your amount owed. 2rLr2Fz@2"c. Call the child abuse hotline at 909-384-9233 (San Bernardino area) or 1-800-827-8724 (outside of San Bernardino). Lassen County Community Social Services Department & Children & Family Services Ms. Jenna Ducasse, Director P.O. 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 Report Waste, Fraud & Abuse, County Job Openings 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. endstream endobj 46 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 49 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 37 0 obj <>/Subtype/Form/Type/XObject>>stream )Vice Chairman/SupervisorFirst District, Jesse ArmendarezSupervisorSecond District, Goals and Objectives Form Number Description Revised Date; SB-598: Settlement Conference Brief: 09/17/13: SB-12039: Stipulation And Order On Request For Order: 11/05/12: SB-19447 Claim Against County of San Bernardino (pdf). San Bernardino County APS strives to have all elders and dependent adults live their lives free from the threat or reality of abuse. If you need CPS help in California, contact Christopher R. Abernathy, APLC, a local practice in San Bernardino, for legal representation. Try it today! Complete CA CFS 125 CPS - San Bernardino County 2013-2022 online with US Legal Forms. 0 0 6.75 7.5 re 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. Preschool services feeds meals to children. Step 1: Apply online through the County's Portal, and submit the $667 initial application fee. Please turn on JavaScript and try again. If not, the site will list the address and phone number of your local courthouse. provides an avenue for reporting fraud, waste, and abuse within SSA's programs and operations. San Bernardino County Workforce Development Board, Community Policy Advisory Committee (CPAC), Cultural Competency Advisory Committee (CCAC), Behavioral Health Commission (BHC) Meeting is Going Dark. Our Family Court division is committed to the processing and management of all domestic matters with integrity, sensitivity and timeliness. California Children's Services Forms. . Requests may be submitted by completing the Request for Judicial Administrative Records Form and sending it to the Court by e-mail or U.S. Mail. 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 anonymously report if they suspect a child is being abused. To file a claim against the County please complete the form below, print, sign and send to the address listed on the form. There are no geographic restrictions. Get e-mail updates on the latest COVID-19 news. 0.749023 g Phone : 800.722.3181 hbbd```b``" 0i"H`s.8C>nf"Ynu8X8=L?jd &7$+: ,"y3L`qQr&):w4"3p vkJ4 Child Abuse Hotline for San Bernardino County is. 1. Follow the installation instructions on Adobe's web site to properly install and configure the Acrobat Reader. Our DIRECT LINE: 1-929-277-7848 to begin today your POWER-session 1-on 1 (Ext.806) Help Form (go to sue cps main site) www.SUECPS.weebly.com or fill out right on this informative site.. Lawyers sadly per state,are not caring enough to file.. To speak to someone about behavioral health services, call 888.743.1478. Fraud, Waste, and Abuse Hotline 800.547.9540. Mail it to us at: SBCO Welfare Fraud, P.O. can be found on the State of California's, Department Human Services works to build a healthy community by strengthening individuals and families, enhancing quality of life, and valuing people. The legal intervention of child welfare agencies, through the judicial (court) system, to protect children and families. . 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. You may be trying to access this site from a secured browser on the server. and at-risk adults in our county. H*2T0T032U0W(J Try it now! Find your local county office. H*2T0T03Tp. H237402VH2P0P32f@(+PP$j 2rMMrFz@^T)T!Q` R 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. 0.749023 g endstream endobj 38 0 obj <>/Subtype/Form/Type/XObject>>stream 1586 0 obj <>stream 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 . 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. In cases of an immediate emergency, always call 9-1-1 for Law Enforcement intervention. This site uses cookies to enhance site navigation and personalize your experience. 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 Save or instantly send your ready documents. 0.749023 g Employment Information and Recruitment Videos. 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 0 8.25 8.625 re Create this form in 5 minutes! 11-22, Affordable Care Act (ACA) 1557 Grievance Procedure, Behavioral Health Services for Clients/Family, Field Testing of Written Materials Policy, Field Testing of Written Materials Procedure, Providing Interpretation Services Procedure, Providing Written Communications in Threshold/Primary Languages for Consumers/Family Members Policy, Incorporated Employees Fiscal Control Procedures, Guidelines For Psychiatrists Assigned to Outpatient Clinics, Deviation from Standard of Practice of Medicine, Control, Access and Accountability of Medications and Medical Supplies Policy, Control, Access and Accountability of Medications and Medical Supplies Procedure, Controlled Substance Utilization Review and Evaluation System (CURES) Policy, Controlled Substance Utilization Review and Evaluation System (CURES) Procedure, Handling of Contaminated Waste/Needles and Syringes, Consent for Administration of Psychotropic Medication to Minors Policy, Laboratory Services/Physical Assessment Policy, Laboratory Services/Physical Assessment Procedure, Medication Authorization for Dependent Children and Youth Policy, Urgent and Emergency Conditions Procedure, Control and Organization of the Standard Practice Manual (SPM) Policy, Requests to Modify Standard Practice Manual Procedure, Department Vision, Mission and Values Policy, Public Information and Media Release Policy, Reimbursement for Travel and Related Expenses, Use of Supplies and Equipment/Notification of Loss or Damage, Furniture and Equipment Relocation Procedure, Assignment of Pagers to Divisions/Programs and Staff, Facility Physical Security and Access Control Policy, Facility Physical Security and Access Control Procedures, Billing and Collection for Treatment Services Policy, Guidelines for Promotional, Educational, and/or Informational Materials, DBH Review Panel for Promotional, Educations, and/or Informational Materials, Review of Promotional, Educational and/or Informational Materials Procedure, Assignment, Closure, Merger or Relocation of Clinics Policy, Closure of DBH Contract Provider Procedure, Assignment of DBH Contract Provider Procedure, Merger of DBH Contract Provider Procedure, Medi-Cal Claim Certification of Authenticity Policy, Intra-Department Reassignment Policy (Supersedes-Employee Reassignment Requests), Waiver for Pre-Licensed/Out-of-State Licensed Ready Psychologists, Registration and Licensure Requirements for Clinical Therapists, Volunteer Request and Registration Procedure, Non-Discrimination / Equal Employment Opportunity, Time and Attendance Form How to Complete, Position Transfer Reassignment & Borrowing Policy, Position Transfer Reassignment & Borrowing Procedure, Procedure for Purchasing Computer Equipment, Request for Information Technology Support Procedure, Computer and Network Appropriate Use Policy, Superseded by myAvatar User Account Creation and Reinstatement Procedure, QShort-Doyle and Short-Doyle/Medi-Cal Clinic Change of Ownership or Location, Requesting an Initial Choice of Provider or Change of Provider Procedure, Requesting an Initial Choice of Provider or Change of Provider Policy, Quality Management Committee Membership/Participation, Pre State Chart Audit Responsibilities & Procedures, Billing Guidelines for Quality Assurance Activities, Outpatient Chart Audit Site Review Policy, Investigating and Reporting Death of a DBH Client, SAMHSA Block Grant-Annual Program Review Procedure, Standard and Expedited Resolution of Appeals Procedure, Consistency in Inpatient and Outpatient Utilization Review and Authorization Practices Policy, Consistency in Inpatient Utilization Review and Authorization Practices Procedure, Consistency in Outpatient Utilization Review and Authorization Practices Procedure, MHP Point of Authorization Plan for Inpatient Psychiatric Hospitalization Protocol, Selection and Retention of Network Provider Policy, Department Liability for Employees and Volunteers Action Outside Work, Electrical Safety Policy: Personal Appliances, Threats Against Federal or State Officials Policy, Threats and Assault on DBH Staff Procedure, Special Incident Reporting Procedure Client Related, Occupational Injury or Illness Reporting Procedure, Local Community Crisis Incident Response Procedure, Office Ergonomics Intervention Program Policy, Interagency Communication of Unusual Events Procedure. 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