Documents & Forms
Residential Recovery Program:
Referral Process (Residential Only) click box below:
Notice of Privacy Practice click box below:
Release of Information Form click box below:
Medi-Cal Beneficiary Handbook webpage click box below:
Drug Medi-Cal (DMC) is type of health insurance that pays for Substance Use Treatment Services (SUTS) to provide treatment services to Medi-Cal beneficiaries. This booklet is a guide to alcohol and drug treatment services under Medi-Cal. It is important that you understand how the drug Medi-Cal insurance plan works so you can get the care you need. This handbook explains your benefits and how to get care. It will also answer many of your questions.
Drug Medi-Cal (DMC) es un tipo de seguro de salud que paga por los servicios de tratamiento de consumo de sustancias (SUTS) para brindar servicios de tratamiento a los beneficiarios de Medi-Cal. Este folleto es una guía de servicios de tratamiento de alcohol y drogas bajo Medi-Cal. Es importante que comprenda cómo funciona el plan de seguro médico de Medi-Cal para que pueda obtener la atención necesaria. Este manual explica sus beneficios y cómo obtener atención. También responderá muchas de sus preguntas.
School Referral Forms and Procedures click box below:
Grievance & Appeal Forms click box below:
If you believe that your rights have been violated during treatment, a three-tiered resolution process is available:
1. Resolving at Provider Level (Advent Group Ministries)
2. Formal Grievance/ Appeal with the County Behavioral Health Services Department
a. Internal hearing is available for uninsured clients (Non Medi-Cal Beneficiary)
3. State Fair Hearing Division (Medi-Cal beneficiary only)
Formal Grievance/ Appeal with County
If you are not satisfied with the Advent Group’s response, you may send the grievance/ appeal to the county’s Behavioral Health Department Services. Note: You may also proceed with filing a grievance/ appeal at anytime to the County. To start the process, you can either:
1. Complete the Grievance & Appeal form in this webpage and give it to your provider, drop it off, or mail it to:
976 Lenzen Ave, 3rd Floor
San Jose, CA 95126
Attention: Clinical Standards Coordinator
2. You may call the Beneficiary Line at 1(408) 792-5666 for assistance in filing your complaint or to speak with an on-call staff from your managed care plan.