- Consent for E-mail – MH 708
- Consent for Observation – MH 701
- Consent of Minor – MH521E
- Los Angeles County Health Agency Notice of Privacy Practices (English)
- Los Angeles County Health Agency Notice of Privacy Practices (Spanish)
- Health Information Exchange (HIE) – Change of Sharing Status – MH 728
- Medication Consent and Treatment Plan – MH 730
- Consent for Secure Text Messaging/Video Chat MH 732
- Consent for TMS MH 733
Consent for Services
- Consent for Services – MH 500E
- Consent for Services (Spanish) – MH 500S
- Consent for Services (Korean) – MH 500K
- Consent for Services (Russian) – MH 500R
- Consent for Services (Tagalog) – MH 500T
Outpatient Medication Review
- Outpatient Medication Review – MH 556 (Effective 9/26/16)
- Outpatient Medication Review (Spanish) – MH 556S (Effective 9/26/16)
- Outpatient Medication Review (Mandarin) – MH 556M (Effective 9/26/16)
- Outpatient Medication Review (Cantonese) – MH 556C (Effective 9/26/16)
- Outpatient Medication Review (Other Chinese) – MH 556OC (Effective 9/26/16)
- Outpatient Medication Review (Korean) – MH 556K (Effective 9/26/16)
- Outpatient Medication Review (Vietnamese) – MH 556V (Effective 9/26/16)
- Outpatient Medication Review (Tagalog) – MH 556T (Effective 9/26/16)
- Outpatient Medication Review (Kmer) – MH 556KM
- Outpatient Medication Review (Arabic) – MH 556A (Effective 9/26/16)
- Outpatient Medication Review (Armenian) – MH 556AR (Effective 9/26/16)
- Outpatient Medication Review (Farsi) – MH 556F (Effective 9/26/16)
- Outpatient Medication Review (Russian) – MH 556R (Effective 9/26/16)
Consent to Photograph/Audio Record
- Consent to Photograph/Audio Record – MH 528
- Consent to Photograph/Audio Record (Spanish) – MH 528S
- Consent to Photograph/Audio Record (Korean) – MH 528K
- Consent to Photograph/Audio Record (Kmer) – MH 528KM
- Consent to Photograph/Audio Record (Tagalog) – MH 528T
- Consent to Photograph/Audio Record (Russian) – MH 528R
Consent for Tele-Psychiatric Services
- Consent for Tele-Psychiatric Services – MH 652
- Consent for Tele-Psychiatric Services (Spanish) – MH 652S
- Consent for Tele-Psychiatric Services (Korean) – MH 652K
- Consent for Tele-Psychiatric Services (Kmer) – MH 652KM
- Consent for Tele-Psychiatric Services (Tagalog) – MH 652T
- Consent for Tele-Psychiatric Services (Russian) – MH 652R
Caregivers Authorization Affidavit
- Caregivers Authorization Affidavit – MH 646
- Caregivers Authorization Affidavit (Spanish) – MH 646S
- Caregivers Authorization Affidavit (Korean) – MH 646K
- Caregivers Authorization Affidavit (Kmer) – MH 646KM
- Caregivers Authorization Affidavit (Tagalog) – MH 646T
- Caregivers Authorization Affidavit (Russian) – MH 646R
Acknowledgement of Receipt