The following helpful resources are for Didi Hirsch clients:
Authorization For Request Or Use Disclosure Of Protected Information
Authorization For Request Or Use Disclosure Of Protected Information (Spanish)
Beneficiary Client Grievance Or Appeal And Authorization Form
Client Request To Access PHI (Spanish)
Consent For Electronic Communication
Consent For Services (Spanish)
Consent To Photograph Audio, Record Display Art Work
SAPC Release – In Network (for Substance Use Treatment)
SAPC Release – Out Network (for Substance Use Treatment)
Beneficiary Non Discrimination Notice (for Substance Use Treatment)
Compliant & Grievance Form (for Substance Use Treatment)
Compliant & Grievance Form (for Substance Use Treatment) (Spanish)
Mental Health Plan – Beneficiary Handbook
Notice Of Privacy Practices (Spanish)
Notice of Privacy Practices (for Substance Use Treatment)
Notice of Privacy Practices (for Substance Use Treatment) (Spanish)
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)
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