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  • Client Info
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  • National Suicide Prevention Lifeline

    If you or someone you
    know is in crisis, call:
    988
    (English/Spanish 24/7)

    Or chat with a crisis counselor:
    CHAT NOW

    *The previous 1-800-273-8255 number will continue to function and will route calls to 988 indefinitely

  • 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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    • Who Was Didi Hirsch?
  • Services
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    • Mental Health
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    • Suicide Prevention Training
    • Student Training Programs
    • Continuing Education
  • Impact
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    • Stories
    • Research & Evaluation
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    • Newsletters
    • Advocacy
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    • Ways to Give
    • Events
    • Volunteer
    • 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 & Counseling Center
    • 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
  • National Suicide Prevention Lifeline

    If you or someone you
    know is in crisis, call:
    988
    (English/Spanish 24/7)

    Or chat with a crisis counselor:
    CHAT NOW

    *The previous 1-800-273-8255 number will continue to function and will route calls to 988 indefinitely

  • 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)

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)

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)

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)

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 MHS
DidiHirschDidi Hirsch MHS@DidiHirsch·
2h

❤️🧡💛 YOU MATTER 💚💙💜

And if you ever feel like you don’t or if you’re struggling emotionally, 24/7 free and confidential emotional support is available when you call 988.

💡 @samhsagov

DidiHirschDidi Hirsch MHS@DidiHirsch·
10h

Repeat after us: I am well-rested and overflowing with energy. ☀️

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