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Resource Documents

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Tools for All Providers

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All Provider Contact List as of 6/09/2015 All Provider Contact List pdf.
All Provider Contact List
250% California Working Disabled Program 7/31/14

California Working Disabled

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)

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

Tools for Care Providers

ARIES

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ARIES Handbook 2015         
ARIES Required and Recommended Data Fields as of 7/30/2015

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 7/30/2015

Sample ARIES consent forms

Definitions for ARIES Client Status

Instructions for Completing ARIES Consent Form as of 4/15/2014

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 1/27/2014

ARIES Screen Shots for Eligibility Verification Acrobat pdf.

ARIES Registration Form as of as of 6/15/15

ARIES Registration Form

Memo: Implementation of ARIES Share Status as of 8/20/2013

Memo: Implementation of ARIES Client Share Status - Acrobat PDF version

ARIES Client Information Sheets as of 7/10/2012

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 7/10/2012

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 12/10/2013 ARIES Reminders for Centerlized Eligibility
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 6/10/15 CalOptima Medi-Cal Network ID
AltaMed Referral Process Memo as of 5/23/2014 Memo

Important Dates

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Prevention Provider Important Dates 2015 as of 4/30/2015

Prevention Provider Important Dates - Acrobat PDF version

Care and Housing Provider Important Dates 2015 as of 4/30/2015

Care and Housing Provider Important Dates

ARIES Newsletters

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

Centralized Eligibility Screening Process FAQs
Dental Services FAQs as of 3/11/2015 Dental Services FAQs - Acrobat PDF version
Dental Services FAQ's Spanish as of 3/11/2015 Dental Services FAQs - Acrobat PDF version
Dental Services FAQ's Vietnamese as of 3/19/2015 Dental Services FAQs - Acrobat PDF version

Centralized Eligibility Screening Process FAQs as of 1/21/2014

 Centralized Eligibility Screening Process FAQs

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 Eigibility and Program Overview as of 7/01/2015 Vietnamese Required Eligibility and Program Overview

Ryan White/HOPWA Requirements to be eligible and qualify for services, Overview of Services that Require a Referral, and Poverty Links as of 4/7/2014

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 2015 Site Visit Tool as of 2/05/2015

Site Visit Tool

Care Services 2015 Site Visit Changes (cheat sheet) as of 2/05/2015

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

English SA Form

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

Vietnamese

English SA Form

Shanti Self-Attestation Form as of 11/05/2014 English


English SA Form
Shanti Spanish Self-Attestation Form as of 11/05/2014 Spanish

Spanish SA Form
Shanti Vietnamese Self-Attestation Form as of 11/05/2014 Vietnamese

Vietnamese SA Form

Care Services Biannual Narrative Report Template as of 2/5/2015

HIV Services Quarterly Narrative Report Template
Housing Services Biannual Narrative Report Template as of 10/30/2013 HOPWA Biannual 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

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 Nutrition and Transportation Services Referral Form as of 3/10/2015 ASF Nutrition and Transportation Referral ASF Nutrition and Transportation
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 Transitional Housing Program Information and Referral Form as of 12/12/2013 ASF Transitional Housing Program Information
APAIT Health Center Mental Health Referral Form 8/1/2014 APAIT MH Referral Form
APAIT Health Center Emergency Financial Assistance Referral Form as of 10/30/2013 APAIT Emergency Housing Program Referral
Five Reminders for Completing Referrals as of 4/15/2014 Five Reminders for Completing Referrals as of 4/15/14
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

Projection Report Template as of 4/30/2015


Projection Report
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 3/11/15

Ryan White Dental Form 

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 8/1/2014 Shanti MH Referral Form
Shanti Orange County Home Delivered Meals Program Form as of 1/08/2014 Shanti OC Home Delivered Meals
START House Referral Form as of 1/06/2014 Start House Referral

Presentations and Fact/Data Sheets

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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 1/06/2015

Prevention Biannual Narrative Report Template

Prevention Materials Review Protocol as of 11/08/2010

Prevention Materials Review Protocol (PDF)

Prevention Materials Review Request Form as of 11/09/2010

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
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 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 7/14/15 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

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 Plan Template for Prevention Services as of 5/19/2014 Prevention QM Template

Quality Management Plans, Reports, and Indicators

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FY13 HIV Planning and Coordination Quality Management Plan 9/17/2013

HIV PAC QM Plan

FY13 Quality Management Report for Care Services as of 5/13/2014

QM Outcomes FF 13

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 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 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 3/01/2014

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
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 3/22/2010

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
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