Forms & Documents


This page is under development.  If a required document is not on this webpage, please email dasallas@saccounty.net.  

Alcohol & Drug Services Forms 

Alcohol & Drug Options for Recovery Brochure (English) 
Alcohol & Drug Options for Recovery Brochure (Chinese)
Alcohol & Drug Options for Recovery Brochure (Hmong)
Alcohol & Drug Options for Recovery Brochure (Russian)
Alcohol & Drug Options for Recovery Brochure (Spanish)

Alcohol & Drug Prevention Services Brochure (English)
Alcohol & Drug Prevention Services Brochure (Chinese)
Alcohol & Drug Prevention Services Brochure (Hmong)
Alcohol & Drug Prevention Services Brochure (Russian)
Alcohol & Drug Prevention Services Brochure (Spanish)

Alcohol & Drug Adult System of Care Brochure (English)
Alcohol & Drug Adult System of Care Brochure (Chinese)
Alcohol & Drug Adult System of Care Brochure (Hmong)
Alcohol & Drug Adult System of Care Brochure (Russian)
Alcohol & Drug Adult System of Care Brochure (Spanish)

Alcohol & Drug Youth Treatment Services Brochure (English)
Alcohol & Drug Youth Treatment Services Brochure (Chinese)
Alcohol & Drug Youth Treatment Services Brochure (Hmong)
Alcohol & Drug Youth Treatment Services Brochure (Russian)
Alcohol & Drug Youth Treatment Services Brochure (Spanish)

Mental Health Services Forms & Documents

Appeal Forms
Appeal Form (English) 
Appeal Form (Arabic)
Appeal Form (Chinese)
Appeal Form (Hmong)
Appeal Form (Russian)
Appeal Form (Spanish)
Appeal Form (Vietnamese) 

Brochures
Access Team Brochure

Advanced Medical Directive Brochure (English) 
Advanced Medical Directive Brochure (Arabic)
Advanced Medical Directive Brochure (Chinese)
Advanced Medical Directive Brochure (Hmong)
Advanced Medical Directive Brochure (Russian)
Advanced Medical Directive Brochure (Spanish)
Advanced Medical Directive Brochure (Vietnamese)

Child and Family Integrated System of Care

Child and Family Psychological Assessment Brochure

Community Support Team Brochure

Mobile Crisis Support Team Brochure 

Notice of Privacy Practices (NOPP) Form 2090 Brochure (legal size)  
Notice of Privacy Practices (NOPP) Form 2090 Brochure (large print) 

Grievance Forms
Grievance Form (English) 
Grievance Form (Arabic)
Grievance Form (Chinese)
Grievance Form (Hmong)
Grievance Form (Russian)
Grievance Form (Spanish)
Grievance Form (Vietnamese)

Medication Forms 
Medication Conversion Chart 

Members' Problem Resolution Posters
Poster (English) 
Poster (Arabic)
Poster (Chinese) 
Poster (Hmong) 
Poster (Russian) 
Poster (Spanish) 
Poster (Vietnamese)

Problem Resolution Guides
Problem Resolution Guide (English) 
Problem Resolution Guide (Arabic)
Problem Resolution Guide (Chinese)
Problem Resolution Guide (Hmong)
Problem Resolution Guide (Russian)
Problem Resolution Guide (Spanish)
Problem Resolution Guide (Vietnamese)

Request for Change of Provider Forms
Request for Change of Provider (English) 
Request for Change of Provider (Arabic)
Request for Change of Provider (Chinese)
Request for Change of Provider (Hmong)
Request for Change of Provider (Russian)
Request for Change of Provider (Spanish)
Request for Change of Provider (Vietnamese) 

Service Verification
Service Verification Report Grid
Service Verification Card  (English)
Service Verification Card (Chinese)
Service Verification Card (Hmong)
Service Verification Card (Russian)
Service Verification Card (Spanish)
Service Verification Card (Vietnamese) 

Suggestion Forms
Suggestion Form (English) 
Suggestion Form (Arabic)
Suggestion Form (Chinese)
Suggestion Form (Hmong)
Suggestion Form (Russian)
Suggestion Form (Spanish)
Suggestion Form (Vietnamese)

Uniform Method of Determining Ability to Pay (UMDAP) Forms
Financial Information Form 
UMDAP Request for Fee Waiver/Reduction  
UMDAP Worksheet

Other Forms
LOCUS Request Form



 
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