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Resource Documents

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Tools for All Providers

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All Provider Contact List as of 9/11/2014 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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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

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 Decision Tree as of 2/06/2014 ARIES Decision Tree
ARIES Registration Form as of 1/09/2014 ARIES Registration Form
ARIES Reminders for Centralized Eligibility as of 12/10/2013 ARIES Reminders for Centerlized Eligibility
ARIES Required and Recommended Data Fields as of 11/05/2013

ARIES Required and Recommended Data Fields - Acrobat PDF version

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

ARIES Screen Shots for Eligibility Verification as of 1/27/2014 ARIES Screen Shots for Eligibility Verification Acrobat pdf.
Sample ARIES consent forms Sample ARIES consent forms

CalOptima Resources

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AltaMed Medical-CalOptima New Patient FAQ
AltaMed Refferral Process Memo as of 5/23/2014 Memo
CalOptima Medi-Cal Networks and Providers Accepting HIV+ Patients List as of 8/6/2014 CalOptima Medi-Cal Network ID

Important Dates

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Care and Housing Provider Important Dates as of 4/30/2014

Care and Housing Provider Important Dates

Prevention Provider Important Dates as of 5/1/2014

Prevention Provider Important Dates - Acrobat PDF version

ARIES Newsletters

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ARIES Advisor December, 2013 Issue December 2013
ARIES Advisor January, 2014 Issue January 2014

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 07/01/2014 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 4/15/2014 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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17th Street Eligibility Verification Information Request Form as of 8/1/2014

Eligibility Verification Form

ASF Eligibility Verification Information Request Form as of 8/1/2014

Eligibility Verification Form

Shanti Eligibility Verification Information Request Form as of 8/1/2014

Eligibility Verification Form

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

Self-Attestation Form Instructions

17th Street Self-Attestation Form as of 5/13/2014

English SA Form

17th Street Spanish Self-Attestation Form as of 5/13/2014

Spanish SA Form

17th Street Vietnamese/Việt Self-Attestation Form as of 5/13/2014

Vietnamese SA Form

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

ASF English SA Form

ASF Spanish Self-Attestation Form as of 5/13/2014

English SA Form

ASF Vietnamese Self-Attestation Form as of 5/13/2014

English SA Form

Shanti Self-Attestation Form as of 5/13/2014 English SA Form
Shanti Spanish Self-Attestation Form as of 5/13/2014 Spanish SA Form
Shanti Vietnamese Self-Attestation Form as of 5/13/2014 Vietnamese SA Form

Care Services Biannual Narrative Report Template as of 11/28/2012

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 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 4/17/2014 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 6/19/2013 Mental Health Service Authorization
Psychiatric Referral Form as of 2/07/2012 Psychiatric Referral
Public Law Center Referral Form as of 11/2013 PLC Referral
Ryan White Dental Referral Process for Providers as of 3/31/2014 Ryan White Dental Referral Process for Providers
Ryan White Dental Referral Form as of 8/15/2014

Ryan White Dental Referral

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    

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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

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

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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 8/12/2011

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
LEO Information and Forms

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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 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 Counseling Information Form as of 7/2012 HIV Counseling Form
Client Assessment Questionnaire effective 7/01/2014 Counseling and Testing
HIV Testing Quality Assurance Plan Template as of 3/12/2014
HIV Test Kit Compentency Checklist as of 11/2013 HIV Test Kit Checklist
HIV Testing Biannual Report Template as of 7/08/2014 HIV Testing Biannual Report 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 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 3/20/2014

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 as of 2/03/2014

In+Care Report

In+Care Report as of 4/29/2014

In+Care Report

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
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

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

HIV Services Quarterly Narrative Report Template