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Resource Documents

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Tools for All Providers

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All Provider Contact List as of 08/17/16 All Provider Contact List pdf.
SUD Contracted Treatment Providers Contact List as of 7/17/2015 

SUD Contracted Contacts

250% California Working Disabled Program 7/31/2014

California Working Disabled

OC Accept                 
Orange County's Healthier Together                 
Overview of County of Orange Behavioral Health Services as of 3/01/2013

Overview of County of Orange Behavioral Health Services (Adobe Acrobat version)

Overview of County of Orange Mental Health Services Act Services as of 7/10/2012

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

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)
Provider’s Guide to HIV Prevention, Care, and Supportive Services as of 10/2011

Download Resource Guide (Adobe Acrobat version)

Training Resources as of 8/31/2010

Training Resources - Acrobat PDF version

HIV PrEP (HIV Pre-Exposure Prophylaxis) Guide as of 8/26/2015
 

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
AIDS on the Front Line Registration Form                                                                                                               

 Registration Form

Rental Assistance Flyer                     English         Spanish 
Client Council Recruitment Flyer           English            Spanish

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 Handbook 2015         
ARIES Required and Recommended Data Fields as of 07/30/15

ARIES Required and Recommended Data Fields - Acrobat PDF version

Eligibility Requirements, Eligibility Document Checklist, and Client’s Signed Statements - Excel version

ARIES Service Unit Guide as of 07/30/15

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 Reminders for Centralized Eligibility as of 12/10/13 ARIES Reminders for Centerlized Eligibility
ARIES Case Management Units Guide as of 03/01/16 RW CM Units Guide
ARIES Case Management Data Entry Guide as of 03/01/16 RW CM Data Entry
Sample ARIES consent forms Sample ARIES consent forms

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
AltaMed Referral Process Memo as of 05/23/14 Memo

Important Dates

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Prevention Provider Important Dates 2016 as of 07/27/16

Prevention Provider Important Dates - Acrobat PDF version

Care and Housing Provider Important Dates 2016 as of 07/19/16

Care and Housing Provider Important Dates

ARIES Newsletters/Data Tips

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MAI Data Tip 01/08/2016
MAI Data tips
ARIES Advisor January, 2016 Issue December 2015
ARIES Advisor December, 2015 Issue December 2015
ARIES Advisor June, 2015 Issue January 2015
ARIES Advisor January, 2015 Issue January 2015
ARIES Advisor November, 2014 Issue November 2014
ARIES Advisor January, 2014 Issue January 2014
ARIES Advisor December, 2013 Issue December 2013

Frequently Asked Questions (FAQs)

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Case Management FAQs as of 04/01/16  English Case Management FAQs
Spanish Case Management FAQs
Case Management Flow Chart as of 11/01/2015 English Case Management Flow Chart
Spanish 
Case Management Flow Chart

Centralized Eligibility Screening Process FAQs as of 6/23/2014

Centralized Eligibility Screening Process FAQs
Dental Services FAQs as of 08/04/16 Dental Services FAQs - Acrobat PDF version

ARIES User FAQs as of 7/10/2012

ARIES User Frequently Asked Questions - 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 05/26/16:

  • 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 LinksRequirements to be Eligible and Qualify
Ryan White Part D - AltaMed Eligibility Requirements as of 2/2014

Templates

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Care Services 2016 Site Visit Tool as of 03/09/16

Site Visit Tool

Care Services 2016 Site Visit Changes (cheat sheet) as of 02/11/16

Site Visit Cheat Sheet

Housing Services 2015 Site Visit Tool as of 02/11/16                 Site Visit Tool
Housing Services 2015 Site Visit Changes (cheat sheet) as of 02/11/16                 Site Visit Cheat Sheet
17th Street Eligibility Verification Information Request Form as of 11/05/2014

English

English

ASF Eligibility Verification Information Request Form as of 11/05/2014

English

English

Shanti Eligibility Verification Information Request Form as of 11/05/2014

English

Eligibility Verification Form

Self-Attestation Form Instructions as of 5/13/2014

Self-Attestation Form Instructions

17th Street Self-Attestation Form as of 11/05/2014

 English


English

17th Street Spanish Self-Attestation Form as of 11/05/2014

Spanish

Spanish

17th Street Vietnamese/Việt Self-Attestation Form as of 11/05/2014

Vietnamese

Vietnamese

ASF Self-Attestation Form as of 11/05/2014

English

ASF English SA Form

ASF Spanish Self-Attestation Form as of 11/05/2014

Spanish

Spanish SA Form

ASF Vietnamese Self-Attestation Form as of 11/05/2014

Vietnamese

English SA Form

Ryan White Case Management Individual Service Plan - 03/01/2016 English SA Form

Ryan White Case Management Psychosocial Assessment Acuity Tools:
as of 03/01/16

Full Acuity Tool(Ryan White Combined Tool)
Case Management Only Tool(Case Management Only)                                   
Linkage to Care Only Tool

(Linkage to Care Only)

Ryan White Case Management Psychosocial Follow-Up Tool Follow-Up Tool
Shanti Self-Attestation Form as of 11/16/2015 English

English SA Form
Shanti Spanish Self-Attestation Form as of 11/16/2015 Spanish

Spanish SA Form
Shanti Vietnamese Self-Attestation Form as of 11/16/2015 Vietnamese

Vietnamese SA Form

Care Services Biannual Narrative Report Template as of 03/08/16

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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Memo: Ryan White Service Providers Re: Client Referral Process as of 2/19/2010

Memo: Client Referral Process (Adobe Acrobat version)

AltaMed Registered Dietician Referral Form as of 2/2014

APAIT Nutrition Services Referral Form as of 02/02/16
AIDS Services Foundation (ASF) Emergency Financial Assistance Form as of 10/28/2013        

ASF EFA Referral

ASF Food Bank Menu as of 2/13/2015 ASF EFA Referral
ASF Local Drug Medication Financial Eligibility Screening as of 11/05/2013 ASF Local Drug Medication Financial Eligibility Screening
ASF Local Drug Health Insurance Payment Assistance Form as of 11/05/2013 ASF Local Drug Health Insurance Payment Assistance
ASF Manufactures Patient Assistance Program (MPAP) Eligibility Form as of 11/7/2013 ASF MPAP Eligibility Form
ASF Mental Health Template as of 8/01/2014 ASF MH Referral Form
ASF Nursing Referral Template as of 11/24/2015 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 12/12/2013 Nutritional Supplements Form
ASF Registered Dietician Referral 05/26/16
ASF Transitional Housing Program Information and Referral Form as of 12/12/2013 ASF Transitional Housing Program Information
ASF Transportation Services Referral Form as of 02/29/16 ASF Transportation Referral
APAIT Health Center Mental Health Referral Form 8/1/2014 MH Assessment
APAIT Health Center Emergency Financial Assistance Referral Form as of 10/30/2013 APAIT Emergency Housing Program Referral
Case Management Referral Form (Fillable) as of 03/17/16 CM Referral Form
Five Reminders for Completing Referrals as of 2/11/2016 Five Reminders for Completing Referrals as of 4/15/14
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 03/17/16 LTC Referral Form
Mental Health Assessment Tool as of 08/04/16 LTC Referral Form
Mental Health Group Sign In Template as of 3/1/2016 Mh Group Sign In
Mental Health Service Authorization Form as of 2/09/2015 MH Authorization
Prevention Referral Instructions as of 2/05/2015 Prevention Referral Instructions
Prevention Referral as of 2/05/2015
Prevention Referral
Prevention Referral Spanish as of 2/05/2015
Prevention Referral
Prevention Referral Vietnamese as of 2/05/2015
Prevention Referral
Psychiatric Referral Form as of 2/07/2012 Psychiatric Referral
Prevention Referral
Public Law Center Referral Form as of 11/2013 PLC Referral
Ryan White Dental Referral Process for Providers as of 11/1/2014 Ryan White Dental Referral Process for Providers
Ryan White Dental Referral Form as of 08/04/16

Ryan White Dental Treatment Plan Template as of 08/04/16                 Ryan White Dental Referral Process for Providers
Ryan White EVF Supplemental Form as of 3/1/2014

 

Sample Justifications for EFA-Housing as of 4/15/2014 Sample Justifications for EFA Housing
Sample Referral Form as of 2/04/2011 Sample Referral
Shanti Mental Health Referral Form 11/16/2015 Shanti MH Referral Form
Shanti Orange County Home Delivered Meals Program Form as of 11/16/2015 Shanti OC Home Delivered Meals
START House Referral Form as of 1/06/2014 Start House Referral
Straight Talk Clinic Mental Health Referral Form 03/01/16 STC MH 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 Continuum of Care Fact Sheet 2013 OC Prevention Progress Report
Orange County Prevention Progress Report OC Prevention Progress Report
Adult Learning Presentation 7/31/14 Paper Puppet Game
  • Adult Learning-Paper Puppet Game 7/31/14
Paper Puppet Game
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
HIVPAC Website Activity 4/15/2014 HIVPAC website activity
Partner Services Presentation 5/01/2014 Partner Services Presentation
Provider Acknowledgement Provider Acknowledgement

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 1/27/2015

Prevention Site Visit Tool

  Prevention SIte Visit Tool  

Prevention Site Visit Tools Changes Cheat Sheet 1/27/15

Cheat Sheet

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 07/14/16

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)


2014 Prevention Program Guidance as of 11/09/2013
2014 Prevention Program Guidance
Projection Report as of 4/30/2015 Projection Report
Quality Management Template as of 03/15/16 QM Template
LEO Information and Forms

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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 Tip June as of 06/03/16 Risk Reductions Activities Form
LEO Data Quality Tip April as of 4/10/2015 LEO Data Quality Tip August 2014
LEO Data Quality Tip August as of 8/21/2014 LEO Data Quality Tip August 2014
LEO Data Quality Tip July 2014 as of 7/10/2014 LEO Data Quality Tip July 2014
LEO Data Quality Tip June 2014 as of 6/13/2014 LEO Data Quality Tip June  2014
LEO Data Quality Tip May 2014 as of 5/01//2014 LEO Data Quality Tip May 2014
LEO Data Quality Tip April 2014 as of 4/01/2014 LEO Data Quality Tip April 2014
LEO Data Quality Tip March 2014 as of 3/27/2014 LEO Data Quality Tip March 2014 as of 3/27/2014
LEO Data Quality Tip February 2014 as of 2/18/2014 LEO Data Tips
LEO Data Quality Tip January 2014 as of 1/09/2014 Data Quality Tips
LEO Data Quality Tip November 2013 as of 11/14/2013 LEO Data Tips

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 07/14/16 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
Quality Management Report Template 03/15/16 QM Plan Template

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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FY15 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 Report October  2015

In+Care Report

In+Care Report August 2015

In+Care Report

In+Care Report June 2015                In+Care Report
In+Care Report April 2015    

In+Care Report

In+Care Report February 2014

In+Care Report

In+Care Report March 2014

In+Care Report

In+Care Report June 2014

In+Care Report

In+Care Report August 2014

In+Care Report

In+Care Report October 2014

In+Care Report

In+Care Report December 2014

In+Care Report

HRSA Policy Notices

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HRSA Policy Notice 15-04 Program Income FAQ's         
HRSA Policy Notice 13-05: Clarifications Regarding Use of Ryan White HIV/AIDS Program Funds for Premium and Cost-Sharing Assistance for Private Health Insurance (6/6/2014)         
HRSA Policy Notice 13-06: Clarifications Regarding Use of Ryan White HIV/AIDS Program Funds for Premium and Cost-Sharing Assistance for Medicaid (6/6/2014)         
HRSA Policy Notice 14-01: Clarifications Regarding the Ryan White Program and Reconciliation of Advance Premium Tax Credits under the Affordable Care Act         
HRSA Policy Notice 15-01: Treatment of Costs under the 10% Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D (3/11/2015)         
HRSA Policy Notice 15-01: Frequently Asked Questions Policy Clarification Notice #15-01 (5/15/2015)         

Ryan White Services Standards of Care

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Case Management Standards of Care as of 04/13/2016

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