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  • Suicide & Crisis Lifeline

    If you or someone you
    know is in crisis, call or text:
    9-8-8
    (English/Spanish 24/7)

    Or chat with a crisis counselor:
    CHAT NOW

    Peer-to-peer support for teens (Teen Line)
    800-852-8336
    6pm-10pm PST

  • Get Services

    For mental health or substance use services, call intake:

    LA County:
    888-807-7250

    Mon-Fri 8:30am-5:00pm

  • Crisis Counseling

    If you or someone you know has experienced thoughts of suicide, made a suicide attempt, or lost someone to suicide, we provide healing during and through your crisis.


    GET HELP TODAY

  • About Us
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  • Services
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    • Suicide Prevention Center Capital Campaign
  • Media
    • Media Queries
    • Recent Coverage
    • Press Releases
    • Media Guidelines
  • Careers
  • About Us
    • COVID-19 Updates
    • Leadership
    • Locations
    • Partners, Grants & Contracts
    • Accreditations & Awards
    • Who Was Didi Hirsch?
  • Services
    • Suicide Prevention
    • Mental Health
    • Substance Use
  • Training
    • Suicide Prevention Training
    • Student Training Programs
    • Continuing Education
  • Impact
    • Erasing Stigma
    • Stories
    • Research & Evaluation
    • Annual Reports
    • Newsletters
    • Advocacy
  • Get Involved
    • Ways to Give
    • Events
    • Volunteer
    • Suicide Prevention Center Capital Campaign
  • Media
    • Media Queries
    • Recent Coverage
    • Press Releases
    • Media Guidelines
  • Careers
  • Client Info
  • DONATE
  • Get Help Now
  • Suicide & Crisis Lifeline

    If you or someone you
    know is in crisis, call or text:
    9-8-8
    (English/Spanish 24/7)

    Or chat with a crisis counselor:
    CHAT NOW

    Peer-to-peer support for teens (Teen Line)
    800-852-8336
    6pm-10pm PST

  • Get Services

    For mental health or substance use services, call intake:

    LA County:
    888-807-7250

    Mon-Fri 8:30am-5:00pm

  • Crisis Counseling

    If you or someone you know has experienced thoughts of suicide, made a suicide attempt, or lost someone to suicide, we provide healing during and through your crisis.


    GET HELP TODAY

Client Resources

  • Home
  • Client Resources

The following helpful resources are for Didi Hirsch clients:

Client Information and Notices

Beneficiary Non Discrimination Notice (for Substance Use Treatment)

HIV TB Pamphlet

Mental Health Plan – Beneficiary Handbook

Notice to Psychotherapy Clients for Licensed Registered Staff

Notice to Psychotherapy Clients for Licensed Registered Staff (Spanish)

Notice to Psychotherapy Clients for Unlicensed Unregistered Staff

Notice to Psychotherapy Clients for Unlicensed Unregistered Staff (Spanish)

Patient Handbook (for Substance Use Treatment)

Patient Handbook Summary (for Substance Use Treatment)

Your Rights Under Medi-Cal (for Substance Use Treatment)

Notice of Open Payments Database

Consent Forms

Consent For Electronic Communication

Consent For Observation

Consent For Services

Consent For Services (Spanish)

Consent Of Minor

Consent To Photograph Audio, Record Display Art Work

Telehealth Telephone Consent For Groups and Family Sessions

Telehealth Telephone Consent For Individual Services

Financial Forms

Financial Obligation Agreement

Financial Obligation Agreement (Spanish)

Financial Screening Checklist

Lifetime Extended Signature Authorization

Payor Financial Information

General Intake Forms

Advanced Healthcare Directive Fact Sheet

Caregivers Affidavit

DMC Multilple Acknowledgment Receipt Form (for Substance Use Treatment)

Multiple Acknowledgment Receipt

Multiple Acknowledgment Receipt (Spanish)

Multiple Party Authorization (for Substance Use Treatment)

 

Medical Records Release

Authorization For Request Or Use Disclosure Of Protected Information

Authorization For Request Or Use Disclosure Of Protected Information (Spanish)

Client’s Request for PHI

SAPC Release – In Network (for Substance Use Treatment)

SAPC Release – Out Network (for Substance Use Treatment)

Client Portal

Client Portal

Patient Rights

Beneficiary Client Grievance Or Appeal And Authorization Form

Compliant & Grievance Form (for Substance Use Treatment)

Compliant & Grievance Form (for Substance Use Treatment) (Spanish)

Complaint & Grievance Form (for Suicide Prevention Center)

Grievance Policy (for Suicide Prevention Center Counseling)

Grievance Policy (for Suicide Prevention Center Crisis Line)

Notice Of Privacy Practices

Notice Of Privacy Practices (Spanish)

Notice of Privacy Practices (for Substance Use Treatment)

Notice of Privacy Practices (for Substance Use Treatment) (Spanish)

Request of Change of Provider (for Suicide Prevention Center Counseling)

Request of Change of Provider (for Suicide Prevention Center Counseling) (SPANISH)

SAPC Grievance Compliant Form

Provider Directory

Provider Directory: Find a Provider

Outcomes

CHOIS (Creating Healthy Outcomes: Integrated Self-Assessment)

CHOIS (Creating Healthy Outcomes: Integrated Self-Assessment) (Spanish)

CHOIS (Creating Healthy Outcomes: Integrated Self-Assessment) (Armenian)

GAD-7 (Generalized Anxiety Disorder)

GAD-7 (Generalized Anxiety Disorder) (Spanish)

Integrated Care Health Behavior Survey – Follow-Up and Discharge

Non-Traditional Services Survey

Non-Traditional Services Survey (Armenian)

PCL-5 (Posttraumatic Stress Disorder)

PCL-5 (Posttraumatic Stress Disorder) (Spanish)

PHQ-9 (Patient Health Questionnaire)

PHQ-9 (Patient Health Questionnaire) – Spanish

PSC (Pediatric Symptom Checklist)

PSC (Pediatric Symptom Checklist) – Spanish

PSC-Y (Pediatric Symptom Checklist Youth)

PSC-Y (Pediatric Symptom Checklist Youth) – Spanish

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Didi Hirsch MHSFollow

Didi Hirsch MHS
DidiHirschDidi Hirsch MHS@DidiHirsch·
25 Mar

Today give yourself permission to feel all the things.

Retweet on TwitterDidi Hirsch MHS Retweeted
MentalHealthAmMental Health America@MentalHealthAm·
24 Mar

More than 40% of undergraduate #college students considered dropping out in the past six months and most cited #mentalhealth and emotional stress as the reason, according to a survey published Thursday by @Gallup and @LuminaFound.

Read more from @CNN: https://cnn.it/3K2v4MQ

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