Formerly Community Mental Health Center
Our Mission Statement
Our mission is to provide the highest quality behavioral health care in a professional, responsive, and caring manner, which is valued by clients, families, communities, and employees.
Navigational Menu
PIM Policy Crosswalk
PIM 1.01 - Administration of the Electronic Data System
PIM 1.02 - Communications Equipment
PIM 2.01 - Standardization of Data
PIM 2.02 - Clinical Records Retention
PIM 2.04 - Forms Management
PIM 3.02 - Security of Clinical Information
PIM 3.03 - Access to PHI by Staff, Contractors, Students and Volunteers
PIM 3.04 - Client Access to PHI
PIM 3.05 - Provision of Accounting of Disclosures of PHI
PIM 3.06 - Minimum Necessary Standards
PIM 3.07 - Designated Record Set
PIM 3.08 - Ensuring Confidentiality of PHI for Remote Staff
PIM 3.09 - Verification of Identity and Authority of Requestor
PIM 5.01 - Data Collected from Stakeholders
PIM 5.02 - Sentinel Events
PIM 5.03 - Outcomes Measures
#109 - Vehicle Preventive Mantenance Inspection Report
#110 - Tranportation Vehicle Safety Inspection Certification
#111 - Annual Safety Inspection Report
#112 - Monthly Fire Extinguisher Inspection
#113 - Approval Emergency Box Inventory
#261 - File Drill Report
#262 - Severe Weather Drill Report
#263 - Building Inspection Sheet
#264 - Equipment Problem Report
#269 - Vehicle Utilization Record
#289 - First Aid Kit Inspection Report
#514 - Self Evaluation of Infection Control Practices
#515 - Staff Infection Control Monitoring
#516 - Refrigerator/Small Appliance Cleaning Schedule
#517 - Medication Refrigerator Cleaning Schedule
#525 - Bomb Threat Checklist
#618 - Infection Alert
#673 - Infection Control Monitoring Checklist
#674 - Infectious Conditions In Staff
#690 - Automatic Fire Extinguishing System
#691 - Clothes Dryers
#692 - Emergency Lighting
#693 - Exhaust Fans
#694 - Fire Alarms
#695 - HAVAC/P/M
#696 - Illuminated Exit Lights
#697 - Natural Gas Detector
#698 - Refrigerator/Small Appliance Cleaning Schedule
#699 - Smoke Detector Battery Operated
#700 - Washing Machine Monthly PM Inspection
#701 - Water Fountain Monthly PM Inspection
#702 - Water Heater Monthly PM Inspection
#704 - Vehicle Equipped for ADA
#718 - Residential Monitoring Checklist
#765 - Emergency Medical Bag Inventory Checklist
#768 - Self Administration of Medicaton Test
#890 - Appliances Annual Preventive Maintenance Inspection
#891 - Total Electrical System Quarterly Preventive Maintenance Inspection
#892 - Severe Weather Container Montly Preventive Maintenance Inspection
#893 - Bomb Threat (Code 66) Drill Report
#894 - Medical Emergency (Code 99) Drill Report
#895 - Psychiatric Emergency (Code Blue) Drill Report
#896 - Weapon Threat (Code 22 ) Drill Report
BF Policies
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BH Policies
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CSB Policies
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HR Policies
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HS Policies
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LD Policies
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MM Policies
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RI Policies
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Alphabetical Listing
Numerical Listing
HR 1.0 - Assignment of Duties
HR 2.1 - Recuritment
HR 2.2 - Selection
HR 3.0 - Identification of Personnel
HR 4.01 - Calculation of Salary Payments
HR 4.02 - Salary Adjustments
HR 4.03 - Advanced Salary Hiring
HR 4.04 - Temporary Salary Supplement
HR 4.05 - Distribution of Paychecks
HR 4.06 - Shift Differential Pay
HR 5.01 - Eligibility for Benefits
HR 5.02 - Flexible Benefits
HR 5.03 - Health Benefits
HR 5.04 - Employee Behavioral Health Services
HR 6.00 - Student/Intern/Practicum Staff Service Agreement
HR 6.01 - Volunteers/Non-Paid Staff
HR 7.01 - Annual, Sick, and Personal Leave
HR 7.02 - Administration of Employee Leave Program
HR 7.03 - Leave of Absence Without Pay
HR 7.04 - Miscellaneous Leave
HR 7.05 - Military Leave
HR 7.06 - Leave Donation
HR 7.07 - Short-Term/Other Leave Without Pay
HR 7.08 - Court Leave
HR 8.00 - Family Leave
HR 9.0 - Fair labor Standards
HR 10.1 - Performance Management Planning and Evaluations
HR 10.2 - Working Test Management Review For Classified Employees
HR 11.0 - Standards of Conduct and Ethics in Government
HR 12.1 - Confidentiality of Personal Information Concerning Employees
HR 13.1 - Grevance Procedure for Classified Employees
HR 13.2 - Grievance Procedure for Unclassified Employees
HR 13.3 - Process for Review of Written Reprimands
HR 14.1 - Equal Employment Opportunity and Unlawful Discrimination
HR 14.2 - Unlawful Discrimination Complaint Procedure
HR 15.0 - Sexual Harrassment
HR 16.1 - Discipliary Actions, Including Adverse Actions for Classified Employees
HR 16.2 - Disciplinary Actions and Separations of Unclassified Employees
HR 18.1 - Workers Compensation and Special Injury Return-to-Work Program
HR 18.2 - Modified Duty Assignment Due to Non-Work-Related Injury/Illness
HR 18.3 - Leave and Payment for Workers Compensation and Special Injury Claims
HR 19.0 - Promotions
HR 20.0 - Separations From Employment
HR 21.0 - Credentialing
HR 22.0 - Clinical Privileges
HR 23.0 - Designation and Re-certification of Mental Health/Mental Retardation/Substance Abuse Professionals/Substance Abuse Managers
HR 24.0 - Licensure/Certification/Registration
HR 25.0 - Clinical Supervision of Non-Licensed Staff
HR 26.0 - Competency Assessment
HR 27.0 - Employee Right To Be Excluded From Patient Care
HR 28.1 - Drug-Free Work Place
HR 28.2 - Alcohol and Drug Testing Programs
HR 29.0 - State Holidays
HR 30.01 - Staff Development
HR 30.02 - Staff Development Off Campus Training Program
HR 30.2 - Staff Development Out-Service Training Program
HR 31.0 - Americans With Disabilities Act
HR 32.0 - Demotions
HR 33.0 - Access to Personnel - Related Public Records Based on the Georgia Open Records Act
HR 34.0 - Third Party Involvement in Employment Issues
HR 36.0 - Unemployment Compensation
HR 37.0 - Retirement
HR 38.0 - Involuntary Separation Retirement Benefits
HR 39.0 - Staff Reduction
HR 40.0 - Movement from Classified to Unclassified Employment
HR 41.0 - Criminal History Records Check
HR 42.0 - Position Level Reduction
HR 43.0 - Verifying Idenity and Employment Eligibility
HR 44.0 - Part-Time Employment
HR 45.0 - Recovery of Overpayments
HR 46.0 - Administrative Closing of Office
HR 47.0 - Other Employment
HR 48.0 - Employment Status of Relatives
HR 49.0 - Political Activity
HR 50.0 - Dress and Appearance Code
HR 51.0 - Employment Reference and other Information Requested
HR 52.0 - Official Hours and Work Schedule
HR 53.1 - Transfer of Employee
HR 53.2 - Interdepartmental Transfers
HR 54.0 - Charitable Contributions Program
HR 55.0 - Preventing Workplace Violence
HR 56.0 - Notices Required to be Posted
HR 57.0 - Employee Suggestion Program
HR 58.0 - Employee Recognition Policy
HR 60.01 - Serving Non-Client Related Subpoenas and Warrants to SBHS Employees
HR 61.0 - Mediation Procedure
HR 62.0 - Reimbursement for Expenses Related To Testing & Training for Certifications
HR 63.0 - Affiliate Personnel
CSB 1.10 - CSB Legal Identity, Bylaws, and Compliance with Laws, Rules, and Regulations
CSB 1.20 - Delegation of CSB Authority
CSB 1.30 - Community Service Board Member Oath of Office
CSB 1.40 - CSB Compliance with Open Meetings Act
CSB 1.50 - CSB Compliance with the Open Records Act
RI 1.01 - Client Rights and Responsiblities
RI 2.01 - Client Right to Treatment/Care and Service Including Transfer/Referral
RI 3.01 - Involvement of Clients in All Aspects of Care, Treatment, and Services
RI 3.02 - Client Input
RI 4.01 - Identification of Staff Responsible For Care, Treatment, and Services
RI 5.01 - The Obtaining of Client's Informed Consent
RI 6.01 - Communication: Language, Vision or Hearing Needs
RI 7.01 - Research on Human Subjects
RI 8.01 - Support Services Offered by Outside Agencies
RI 9.01 - Advance Directives
RI 10.01 - Individual Right to Privacy and Security
RI 11.01 - Confidentiality Policy and Procedures for Obtaining Authorization for the Disclosure of Protected Health Information (PHI)
RI 11.02 - AIDS Confidential Information
RI 12.01 - Notice of Privacy Practices
RI 13.01 - Individual Right to Request Restrictions On the Use of Protected Health Information (PHI)
RI 13.02 - Amendment of Protected Health Information
Ri 13.03 - Client Right to Confidential Communications
RI 13.04 - Access to Protected Health Information
RI 13.05 - Client Access to Protected Health Information
RI 13.06 - Provision of Account of Disclosures of Protected Health Information to Clients
RI 13.07 - Minimum Necessary Standard
RI 13.08 - Designated Records Set
RI 13.09 - Ensuring Confidentiality of Protected Health Information for SBHS Staff Working Away from a Facility Setting
RI 13.10 - Verification of Identity and Authority of Requestor
RI 14.01 - Individual Work Programs
RI 15.01 - The Safeguarding of Individual Valuables and Individual Funds
RI 15.02 - Management and Protection of Funds of Individuals Served
RI 15.03 - CSP: The Safeguarding of Individual Valuables and Individual Funds
RI 16.01 - Resolution of Client Complaints/Rights Violations
RI 17.01 - Behavior Support
RI 17.02 - Therapeutic Holding/Emergency Interventions
RI 17.03 - Restraint and Seclusion
RI 17.06 - CSP: Client Access to Telephone, Mail and Visitors
RI 18.01 - Respect for Diversity and Commitment to Cultural Competence
RI 19.01 - Ethics and Compliance Program
RI 20.01 - CSP: Spiritual and Pastoral Services
RI 21.01 - CSP: Photographing of Clients
RI 80.10 - CSP: Spiritual and Pastoral Services
RI 80.11 - CSP: Use of Seclusion and Restraint
RI 80.12 - CSP: Room Search/Unit Search
RI 80.13 - CSP: Client Access To Telephone, Mail and Visitors
RI 80.14 - Personal Searches in the Crisis Stabilization Program
RI 80.16 - CSP: Verbal Telephone Authorized Consent
RI 80.17 - CSP: Manual/Emergency Interventions
RI 80.18 - CSP: Behavior Support
RI 80.19 - CSP: The Safeguarding of Client Valuables
RI 80.20 - CSP: Photographing of Clients
RI 90.10 - C&A CSP: Spiritual and Pastoral Services
RI 90.11 - C&A CSP: Use of Seclusion and Restraint in the Crisis Stabilization Program
RI 90.12 - C&A CSP: Room Search/Unit Search
RI 90.13 - C&A CSP: Client Access to Telephone, Mail and Visitors
RI 90.14 - C&A CSP: Personal Searches
RI 90.15 - C&A CSP: Withdrawal to Quiet Area
RI 90.16 - C&A CSP: Verbal Telephone Authorized Consent
RI 90.17 - C&A CSP: Manual/Emergency Interventions
RI 90.18 - C&A CSP: Behavior Support
RI 90.19 - C&A CSP: The Safeguarding of Client Valuables
CSB Members
Resource Links
Augusta
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McDuffie
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Wilkes
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Community Housing
Day and Employment Services
Family Support/Respite
Supported Living
Adult Outpatient
Mental Retardation/Developmental Disabilities
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Forms Register
All Forms
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Business Forms
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Clinical Forms
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CSP Forms
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HR Forms
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Other Forms
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Non Serenity Forms
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CARF Crosswalk to Standards 1
CARF Crosswalk to Standards 2
CARF Crosswalk (Section 18, 1C6, and 1E)
CARF Crosswalk (Section 2C)
HS 1.10 - Physical/Therapeutic Environment
HS 1.11 - Health and Safety Committee
HS 1.12 - Safety Officer
HS 1.13 - Facilities Maintenance
HS 1.14 - Safety Education
HS 1.15 - Information Collection and Evaluation
HS 2.10 - Emergency Code Drills
HS 2.11 - "Code 22" Weapon Threat
HS 2.12 - “Code 66”, Bomb Threat
HS 2.13 - “Code 99”, Life Threatening Medical Emergency
HS 2.14 - “Code Blue”, Psychiatric Emergency
HS 3.10 - Safe Environment
HS 3.12 - Physical Environment
HS 3.13 - Weapons Management
HS 3.14 - Hazardous Materials and Waste
HS 3.15 - Emergency/Disaster
HS 3.16 - Fire Safety
HS 3.17 - Equipment Management
HS 3.18 - Utilities Management
HS 3.19 - Terroristic Threats
HS 4.06 - Key Issuance and Control
HS 4.11 - Safety in Outreach
HS 4.12 - Planning and Conducting Safe Recreational Activities
HS 4.13 - Missing Person
HS 5.10 - First Aid
HS 5.11 - Smoking
HS 5.12 - Vehicle Administration
HS 5.13 - Availability and Care of Pets and Other Animals
HS 50.00 - Statement of Authority
HS 50.10 - Implementation of Infection Control Policies
HS 50.20 - Bloodborne Pathogen Exposure Control Plan
HS 50.21 - The OSHA Bloodborne Pathogen Standard
HS 50.22 - Infection Control Orientation and Training
HS 50.30 - Health and Safety Monitors
HS 50.31 - Employee Health
HS 50.40 - Infection Control Monitoring
HS 50.41 - Standard Precautions
HS 50.42 - Notifiable Diseases
HS 50.43 - Identification, Surveillance, and Reporting of Infections
HS 50.44 - Infection Control Methods
HS 50.45 - Work Practice Controls
HS 50.46 - Staff Compliance with Infection Control
HS 50.47 - Personal Protective Equipment (PPE)
HS 50.50 - Handwashing
HS 50.51 - Employee Hygiene
HS 50.60 - Enginerring Controls
HS 50.61 - Thermometer Cleaning
HS 50.62 - Management of Training Aids and Toys
HS 50.63 - Inventory Control of Supplies
HS 50.70 - Specimen Collection
HS 50.71 - Laboratory Specimen Collection Site
HS 50.72 - Cleaning and Disinfection Practices
HS 50.73 - Community Residential Service Delivery Sites: Laundry Processing for Personal Items
HS 50.80 - Role of Facility Maintenance in the Prevention and Control of Infection
HS 50.81 - Housekeeping Practices for Infection Control
HS 50.82 - Waste Management
HS 50.83 - Pest Control
HS 50.84 - Ice Chests/Coolers and Ice Machines
HS 50.85 - Refrigerators/Freezers
HS 50.90 - Performance Improvement for Infection Control
HS 80.10 - CSP: Infection Control: Management of Clients with Tinea Pedis (Athlete's Foot)
HS 80.11 - CSP: Infection Control: Pediculosis (Lice)
HS 80.20 - CSP: Housekeeping: Cleaning of Kitchen-Type Appliances
HS 80.21 - CSP: Housekeeping: Disinfecting of Equipment
HS 80.22 - CSP: Housekeeping: Clean and Soiled Linen
HS 80.23 - CSP: Laundry Processing for Personal Items
HS 80.30 - CSP: Dietary Protocol: Dry Food Storage
HS 80.31 - CSP: Dietary Protocol: Disposal of Waste (Food Service)
HS 80.50 - CSP: Environmental Rounds
HS 80.51 - CSP: Clearing the Unit
HS 80.52 - CSP: Elopement
HS 80.53 - CSP: Physical/Therapeutic Environment
HS 80.55 - CSP: Sharps
HS 80.58 - CSP: Staff Dress Code
HS 80.59 - CSP: Emergency/Disaster Plan
HS 80.60 - CSP: Cleaning of Restraints
HS 90.10 - C&A CSP: Infection Control: Management of Clients with Tinea Pedis (Athlete's Foot)
HS 90.11 - C&A CSP: Infection Control: Pediculosis (Lice)
HS 90.20 - C&A CSP: Housekeeping: Cleaning of Kitchen-Type Appliances
HS 90.21 - C&A CSP: Housekeeping: Disinfecting of Equipment
HS 90.22 - C&A CSP: Housekeeping: Clean and Soiled Linen
HS 90.23 - C&A CSP: Laundry Processing for Personal Items
HS 90.30 - C&A CSP: Dietary Protocol: Dry Food Storage
HS 90.31 - C&A CSP: Dietary: Disposal of Waste (Food Service)
HS 90.50 - C&A CSP: Environmental Rounds
HS 90.51 - C&A CSP: Clearing the Unit
HS 90.52 - C&A CSP: Elopement
HS 90.53 - C&A CSP: Physical/Therapeutic Environment
HS 90.55 - C&A CSP: Sharps
HS 90.58 - C&A CSP: Staff Dress Code
HS 90.59 - C&A CSP: Emergency/Disaster Plan
HS 90.60 - C&A CSP: Cleaning of Restraints
Home
Locations
Forms
Policies
Human Resources
Serenity Times
Resources
Employment Opportunities
Employee Email
Critcal Incident Report
Pre-Admission Referral Form
Budget Form
DHR Adult Core Customer Eligibility Determination Form
DHR C&A Core Customer Eligibility Determination Form
Wash Your Hands
Non-Emergency Transportation Cancellation Report
Daily Trip Log Non-Billable Clients
Daily Trip Log
DHR Financial Assistance Form
Med Watch Form 3500
#119 - Recommendation of Clinical Supervisor
#120 - Recommendation of Admistrative Supervision
#122 - Transitional Employment Plan
#123 - Transitional Employment Tracking
#124 - Attending Physician's Statement of Functional Capabilities
#150 - Job Requirments/Conditions of Employment
#274 - SBHS Grievance Form
#300 - Memo/Pre-Employment Drug Screening
#306 - Students/Volunteers/Interns Agreement
#307 - Students/Volunteers/Interns Application Forms
#308 - Volunteers Record of Hours
#338 - Sample Approval of Family Leave Serious Health Condition - Employee
#341 - Acknowledgment of Responsibility to Maintain Current License, Certificate or Registration
#348 - Consent for Release of Information
#349 - Request for Credentialing Information
#363 - Family and Medical Leave Request Form
#364 - FLSA Compensatory Time Reporting Record
#366 - Certification of Pregnancy/Child Birth
#369 - Certification of Serious Health Condition for Family Leave
#370 - SBHS Request to Solicit Leave Donation
#371 - SBHS Leave Donation Authorization
#376 - Employee Record
#401 - Request for Leave
#407 - Employment of Relatives
#416 - Direct Deposit
#420 - Sample Denial of Family Leave
#422 - Right to File A Request for Review of PMF
#425 - Acknowledgment of Provisions Governing Interdepartmental Transfer
#426 - Understanding Concerning the Use of FLSA Compensatory Time
#427 - Drug-Free Workplace Notice
#430 - Designation for Outstanding Wage Payments
#436 - Appointment Notice
#457 - Selection of Payment Option
#463 - FLSA Classification/Work Week
#475 - Breath Alcohol Testing Form
#500 - Employee Time and Leave Record
#501 - Clincal Privileges
#502 - Individual Documentation of Clinical Supervision
#504 - General Orientation Competency Measures Checklist
#505 - Workplace Orientation Competency Checklist
#506 - Training Roster
#508 - Notification Concerning Polygraph Examinations
#509 - Voluntary Stipulation of Polygraph Examination
#510 - Voluntary Underatanding of Polygraph Examination
#511 - Refusal to Submit to Polygraph Examination
#513 - Volunteer Evaluation Form
#518 - Workers Compensation & Special Injury Return-to-Work Program
#541 - Exemption Statement
#542 - Request for Out-Service Training
#551 - Unlawful Discrimination Complaint Form
#556 - Acknowledge of Position Status (new hire)
#559 - Clearance Checklist for Separating Employees
#561 - Designation of Family Leave Without a Request
#562 - SBHS Solicitation for Leave Donations
#565 - Designation of Conditional Family Leave
#566 - CMHC Incident Report Employee
#569 - Crinimal History Record Checks for SBHS
#575 - Applicant Screening Letter
#576 - Offer of Employment Letter
#577 - Notification of Non-Selection
#579 - Random Drug Screening
#580 - Report for Pre-Employment Drug Testing
#582 - Random Alcohol Screening
#583 - Georgia Crime Information Center Awareness Statement
#588 - Performance Plan Review
#590 - Code of Ethics for Government Service
#594 - Letter of Transfer
#595 - Detailed Job Analysis
#596 - Approval Notice - Physician Specific Period of Disability
#597 - Approval Notice - Period of Disability Note Specified by Physician
#598 - Extension Notice - Physician Gives Specific Period Disability
#599 - Extension Notice - Period of Disability Note Specified by Physician
#600 - Leave Denial Notice
#605 - Authorization for Release of Medical Information
#606 - CMHC Reprimand Review Form
#610 - Sample Disclosure of Info.Recd From GCIC and/or FBI
#611 - Salary & Employment Verification
#612 - Transferring of Employee
#613 - Promotion without Salary Advancement Agreement
#614 - Special Request for Approval of Other Employment
#615 - Standard Request for Approval of Other Employment
#650 - Application Flow Data
#652 - Employment Interview Report
#653 - Exit Interview
#654 - Child & Adolescent
#655 - Residential Site Employees
#656 - Application for Pre-Screening
#657 - Payroll Coding Sheet
#659 - Employee Timesheet
#661 - Overtime Request
#662 - Finter Print Expenses
#663 - MRF's Transmittal Sheet
#664 - Employees for Orientation
#665 - Applications for Review and/or Interview
#713 - Certification of Adoptio or Foster Care
#714 - Employee Information Sheet
#715 - Standards of Conduct Acknowledgement
#716 - Adknowledgement of Workers Compensation
#717 - Selective Service Verification
#719 - Driver's License Log
#727 - Confidentiality Agreement
#736 - Exit Interview Questionnaire for Voluntary Separation
#736 - Voluntary Exit Interview Questionnaire
#747 - Course/Program Description
#756 - Training Evaluation Form
#775 - Competencies Assessment Checklist
#777 - Nurse's Competency Checklist
#804 - MVR Information & Consent Form
#805 - Employee Competency Checklist
#835 - C.P. Memo
#850 - Previous Employer Reference Check
#864 - Transcript Request
#873 - Workplace Acts of or Threatened Acts of Violence Report
#874 - Nomination Form for Employee of the Quarter
#875 - Request for Certification Reimbursement
#876 - Mediation Request
#879 - Volunteer/Visitor Incident Report
#880 - Request for Use of SBHS Credit Card
#881 - Resignation Repayment Agreement
#882 - Repayment Agreement
#883 - Recovery Agreement
#886 - Facility Accessibility Audit
#887 - Facility Accesibility Audit Correction Report
#888 - SBHS Grievance Group Roster
#902 - Georgia Open Records Act Human Resources Request Form
#926 - Release to Return to Work
#933 - Code of Conduct and Code of Ethics Certification of Compliance
#948 - Notification of Purged Records
#951 - Grievance Form for Unclassified Employees
#952 - Grievance Group Roster
#953 - Management Review Form
BH Policy Index
BH 1.01 - Initial Screening
BH 2.01 - Initial Assessment
BH 2.02 - Further Assessments/Reassessments
BH 2.03 - Crisis Assessment and Crisis Intervention
BH 2.05 - Victims of Abuse and Neglect
BH 2.06 - Outpatient: Initial and Subsequent Nursing Assessmen
BH 3.01 - Admission and Readmission Criteria
BH 3.02 - Planning List
BH 4.01 - Treatment Planning
BH 4.02 - Client Use of Others Regarding Care Decisions
BH 4.03 - Conflict in Consumer Care Decisions
BH 5.01 - Consumer Orientation/Education
BH 6.01 - Clinical Care Documentation
BH 6.02 - Clinical Record
BH 6.03 - Case Management Programs
BH 6.04 - Community Housing
BH 6.05 - Community Integration Programs
BH 6.06 - Intensive Family-Based Services
BH 6.08 - Supportive Living
BH 6.09 - C&A Outpatient Treatment
BH 6.10 - Private Home Care Licensure and Services
BH 7.01 - Transition or Transfer/Referral Process
BH 8.01 - Discharge Planning
BH 8.02 - Administrative Removal from Services
BH 8.03 - Clinical Record Maintenance and Storage
BH 9.01 - Utilization Review
BH 10.00 - Treatment Team
BH 20.10 - MR/DD Employment Services Provision
BH 20.20 - MH/AD Employment Services Provision
BH 20.30 - Respite Services
BH 80.01 - CSP: Crisis Stabilization Program: Admission, Exclusionary, Continued Stay Criteria and Discharge Criteria
BH 80.02 - CSP: Admission Procedures
BH 80.03 - CSP: Involuntary Admission
BH 80.04 - CSP: Voluntary Admission
BH 80.05 - CSP: Transition/Discharge Planning
BH 80.06 - CSP: Activity/Progress Note
BH 80.07 - CSP: Levels of Observation
BH 80.10 - CSP: Against Medical Advice (AMA) Discharges
BH 80.20 - CSP: Staffing Patterns
BH 80.30 - CSP: Education Log
BH 80.40 - Adult CSP: Transitional Beds
BH 80.50 - CSP: Shift Communications
BH 80.60 - CSP: Non-Admit Cae Follow-Up
BH 90.01 - C&A CSP: Admission, Exclusionary, Continued Stay, and Discharge Criteria
BH 90.02 - C&A CSP: Admission Procedures
BH 90.03 - C&A CSP: Involuntary Admission
BH 90.04 - C&A CSP: Voluntary Admission
BH 90.05 - C&A CSP: Transition/Discharge Planning
BH 90.06 - C&A CSP: Subsequent Nursing Assessments/Activity Notes
BH 90.07 - C&A CSP: Request for Discharge
BH 90.08 - C&A CSP: Transfer Policy
BH 90.10 - C&A CSP: Against Medical Advice (AMA) Discharges
BH 90.10 - C&A CSP: Request for Discharge and Against Medical Advice (AMA) Discharges
BH 90.15 - C&A CSP: Request for Discharge
BH 90.16 - C&A CSP: Legal Status of Persons Admitted
BH 90.20 - C&A CSP: Staffing Patterns
BH 90.30 - C&A CSP: Client/Family Education
BH 90.40 - C&A CSP: Transitional Beds
BH 90.50 - C&A CSP: Shift Communications
BH 90.60 - C&A CSP: Reporting of Non-Admits
CSP: Clinical Record Format
#285 - Inventory of Personal Property
#809 - Environmental Rounds Inspection Report
#810 - Physical Examination
#811 - Vital Signs Flow Sheet
#812 - Admission Medical Assessment
#813 - Advance Directives
#814 - Checklist for Form 1007
#815 - Checklist for Form 1010
#816 - Checklist for Form 1012
#817 - Checklist for Form 1013/2013
#818 - Checklist for Forms 1014/2014
#819 - Checklist for Forms 1013/2013, 1012, 1014/2014
#820 - Sharps Monitoring Form
#822 - Seclusion or Restraint Order and Physicain Progress Note
#824 - Physician/CNS Assessment of Seclusion/Restraint
#825 - Care, Intervention and Observation Codes for Seclusion/Restraint
#826 - Controlled Drug Record
#827 - Visitor Sign In Log
#828 - Approval of Visitation and Phone Calls
#829 - Client Satisfaction Survey
#830 - Medication Receipt
#834 - Sign-out Sheet for After-Hours Medication Cabinet
#840 - Consent for Treatment
#841 - Continuity of Care Discharge Summary
#843 - PRN Medication Administration Record
#845 - Psychiatric Admission Standing Orders
#846 - Opiod Detoxification Standing Orders
#847 - Standing PRN Medication Orders
#848 - CSP Audit Checklist
#857 - CSP Referral/Disposition Log
#858 - CSP Discharge Log
#859 - CSP Environmental Rounds
#861 - Physician's Orders
#862 - Clinical Alert
#866-P - CSP Service Ticket
#877 - CSP: Treatment Team/Transition Planning
#885 - Referral Log
#900 - Levels of Observation
#920 - CSP: Alcohol Detoxification Standing Orders
#922 - CSP: Client Group Education
#927 - CSP: Seclusion and/or Restraint Record
#928 - CSP: Medication Sheet
#929 - CSP: Non-Admit Care Instructions
#930 - CSP: KARDEX
#931 - Notification Regarding Potential Use of Restraint and Seclusion
#936 - CSP: Quiet Time for Children and Adolescents
#938 - CSP: Client Items Received
#942 - Parental Consent for Interim Placement
#943 - Notification of Restraint and Seclusion
#944 - Involuntary Admission of Psychotropic Medication Form
#945 - C&A Admission Orders
#946 - C&A Routine PRN Medications
#949 - Group Training/Counseling Note
#950 - Physician Progress Note
#1009 - Application for Voluntary Admission
#1010 - Request for Discharge By Voluntary Client
#1011 - Notice of Voluntary Clients Right to Request Discharge
#1012 - Transfer to Voluntary Status
#1015 - Notice of Rights to Hearing
#1019 - Notice of Discharge from Emergeny Receiving and Evaluating Facility
#1025 - Notice of Representative's Consultation and Notification Rights
#1025A - Notice of Representative's Consultation and Notification Rights
#1026 - Notice of Representative's and Guardian's Consultation and Notification Rights
#1026A - Notice of Representative's Consultation and Notification Rights
#2009 - Application for Voluntary Admission
MM 1.10 - Pharmacy Operations
MM 1.20 - Physicians/APRN's/PA's Authorized to Prescribe/Order Medications
MM 1.30 - Verbal/Telephone Medication Orders to the Pharmacy
MM 1.40 - Non-Formulary Drugs
MM 1.50 - Dispensing Policy
MM 1.60 - Destruction of Therapeutice Medications
MM 1.61 - Destruction of Illicit Substances
MM 2.01 - Medication Storage
MM 2.02 - Medication Storage Inspections
MM 2.03 - Multi-Dose Vials
MM 2.04 - Investigational Drugs/Drug Studies
MM 2.05 - Schedule II Drugs
MM 2.06 - Drug Recall Policy
MM 2.10 - Medication Use and Monitoring Policy
MM 2.11 - Use of Psychotropic Medications in Females of Child Bearing Age and Pregnant Individuals
MM 2.12 - Depo Provera
MM 2.20 - Client's Personal Medication
MM 2.30 - Patient Assistance Program
MM 2.55 - Use of Benzodiazepines
MM 2.56 - Use of Psychostimulants Adult Population
MM 3.10 - Pharmacy and Therapeutics Committee
MM 3.11 - Drug Utilization Review (A Subcommittee of P & T)
MM 4.01 - Informed Consent for Medication
MM 4.02 - Prescriptions for Medication
MM 5.10 - "Sample" Medication Policy
MM 5.20 - Over-the-Counter Medications
MM 5.30 - Medication Administration
MM 5.31 - Self-Administration of Medication (Non-Residential Settings and Day Services Settings)
MM 5.32 - Medication Administration Documentation
MM 5.33 - Authorization of Verbal and Telephone Orders
MM 5.34 - Self-Administration of Medications for Residential Clients in Non-24 Hour Supervised Settings or Contracted Sites
MM 5.35 - Self-Administration of Medication Documentation for MR Staffed Residential Services
MM 5.36 - Supervision of Self-Administration of Medications in 24 hour MR Residential Staffed Sites
MM 5.37 - Managemet of Medication for Clients Who Have Taken Leave from Residential Care
MM 6.10 - Medications Contained in the Emergency/AED Cart
MM 7.10 - Adverse Drug Reactions
MM 7.11 - Medication Discrepancies
MM 8.11 - Oral Health Care
MM 8.12 - Pain Assessment
MM 9.10 - Medical Services - Personnel
MM 9.11 - Medical Director
MM 9.12 - Outpatient: Physician’s Responsibilities
MM 9.13 - Physical Health Screening and Assessment
MM 9.15 - Initial and Subsequent Nursing Assessment
MM 9.16 - Medication Profile and Past Medication History
MM 9.20 - Debriefings: Policies and General Procedures
MM 10.10 - Laboratory Testing for Person's Served
MM 10.11 - Contract Laboratory Services
MM 10.12 - Whole Blood (Fingerstick) Glucose Waived Testing
MM 10.13 - Specified Testing - Related Proceses
MM 10.14 - Glucometers
MM 11.10 - HIV/AIDS Services
MM 12.10 - Outpatient: Psychiatric Hospitalization of Person Served
MM 12.13 - Documentation of Telephone Triage/Contacts
MM 14.10 - PRN Medications Used In Community Residential Settings
MM 15.01 - Medication Education
MM 19.00 - Medications Contained in the Emergency/AED Cart
MM 32.00 - Nutrition Care
MM 33.00 - Oral Health Care
MM 34.00 - Pain Assessment
MM 40.00 - Medication Profile and Past Medication History
MM 42.00 - Medical Director
MM 46.00 - Hospitalization of Persons Served
MM 50.00 - Contract Laboratory Services
MM 54.00 - Documentation of Telephone Triage/Contacts
MM 80.05 - CSP: Informed Consent for Medications
MM 80.10 - CSP: Self-Administration of Medication
MM 80.20 - CSP: Vital Signs
MM 80.30 - CSP: Admission/Medical Assessment
MM 80.35 - CSP: Physical Health Screening and Assessment
MM 80.40 - CSP: Tuberculosis and STD Screening
MM 80.45 - CSP: Nutrition Care
MM 80.50 - CSP: Pharmacy Services
MM 80.55 - PRN Medications Used In The Crisis Stabilization Program (CSP)
MM 80.60 - CSP: Floor Stock
MM 80.70 - CSP: Emergency Medications Administration
MM 80.80 - CSP: Medications Brought with the Client
MM 80.90 - CSP: Unit Dose Dispensing System
MM 80.91 - CSP: Medication Storage
MM 80.92 - CSP: Controlled Substances
MM 80.93 - CSP: Referral to Treatment Facilities
MM 80.94 - CSP: Initial Nursing Assessment
MM 80.95 - CSP: Physician’s Responsibilities
MM 90.05 - C&A CSP: Informed Consent for Medication
MM 90.10 - C&A CSP: Self-Administration of Medication
MM 90.20 - C&A CSP: Vital Signs
MM 90.30 - C&A CSP: Admission/Psychiatric/Medical Assessment
MM 90.35 - C&A CSP: Physical Health Screening and Assessment
MM 90.40 - C&A CSP: Tuberculosis and STD Screening
MM 90.45 - C&A CSP: Nutrition Care
MM 90.50 - C&A CSP: Pharmacy Services
MM 90.55 - C&A CSP: PRN Medications Used In the Crisis Stabilization Program
MM 90.60 - C&A CSP: Floor Stock
MM 90.70 - C&A CSP: Emergency Medications Administration
MM 90.80 - C&A CSP: Medications Brought with the Client
MM 90.90 - C&A CSP: Unit Dose Dispensing System
MM 90.91 - C&A CSP: Medication Storage
MM 90.92 - C&A CSP: Controlled Substances
MM 90.93 - C&A CSP: Referral to Treatment Facilities
LD Policy Crosswalk
LD 1.01 - Policies and General Procedures
LD 1.02 - Format for Policies and General Procedures
LD 1.03 - Standard Operating Procedures (SOP's)
LD 2.01 - Leadership Team Composition and Function
LD 2.02 - Committee Structure
LD 2.03 - PRIME Team
LD 3.01 - Access to the Attorney for CSB
LD 4.01 - Strategic, Operations and Program Related Planning
LD 5.01 - Risk Management
LD 6.02 - Vision, Mission, Values, and Strategic Planning
LD 7.01 - Behavioral Health Promotion
LD 8.01 - Subpoena Administration and Response
LD 9.00 - Reporting of Consumer Deaths and Critical Incidents
LD 9.01 - Workforce Incident Management
LD 9.02 - Investigating Consumer Deaths and Critical Incidents
LD 10.00 - Documentation of Meeting Minutes
LD 80.04 - CSP: Quality Improvement Program
LD 90.04 - C&A CSP: Quality Improvement Program
BF Policy Index
BF Policy Crosswalk
BF 1.00 - Accounting System
BF 2.00 - Budget Planning System
BF 3.00 - Cash Flow Analysis
BF 4.00 - Audits - Financial
BF 5.00 - Fiscal Business Operations
BF 6.00 - Accounts Payable/Cash Disbursements
BF 7.00 - Sub-Contracts
BF 8.00 - Anti-Fraud
BF 9.00 - Fiscal Management, Working Capital, and Contingency Needs
BF 10.00 - Handling Facility Monies
BF 10.01 - Protection of Cash Receipts by Mail
BF 10.02 - Donations
BF 10.03 - Excess, Missing or Stolen Cash
BF 10.04 - Fee Collection and Preparation
BF 11.00 - Unanticipated Deficit Actions
BF 12.00 - Notification of New Program Expenditures
BF 13.00 - Damage to Personal Property
BF 14.00 - Determination of Fees & Billing Clients for Services
BF 14.01 - Application of Sliding Fee Scale
BF 14.02 - Guidelines for Providing & Documenting MH/AD Services Billable to Medicaid
BF 14.03 - Accountability for Mental Health/Addictive Disease Units of Service
BF 14.04 - Verification of Lawful Presence in the United States
BF 14.11 - Application of Sliding Fee Scale for Pharmaceuticals
BF 14.12 - Determination of Client Fees for Clients Enrolled in Mental Health Residential and PATH Programs
BF 15.00 - Aging and Writing Off Accounts
BF 15.01 - Bad Debits
BF 15.05 - Billing Error Notification
BF 16.00 - Returned Checks for Insufficient Funds
BF 17.00 - Travel and Subsistence
BF 17.01 - Emergency Travel Expenses
BF 18.01 - Vehicle Insurance
BF 19.00 - Client Transportation
BF 20.01 - Purchasing and Acquisition
BF 20.02 - Requisitioning Procedures
BF 20.03 - Shipping and Receiving Services Guidelines
BF 20.04 - Inventory Tracking and Management
BF 21.00 - Insurance Coverage
BF 22.00 - Non-expendable Personal Property
BF 23.00 - Representative Payee-Conserved Funds
BF 24.00 - Payroll
BF 25.00 - Mail Handling, Shipping and Receiving Services
BF 25.01 - Outgoing Mail
BF 25.02 - Interdepartmental and Incoming Mail Preparation Guidelines
BF 25.03 - Guidelines for Delivery of Paychecks
BF 25.04 - Guidelines for Delivery of Deposits
BF 26.00 - Telephone Procedures
BF 26.01 - Communication Equipment
BF 26.02 - Administration of the Electronic Data System
BF 26.03 - Security of Electronically Stored Clinical Information
BF 27.00 - Standardization of Data and Record Sets
BF 27.01 - Data Collected From Stakeholders
Serenity Letterhead
#108 - Request for Client Access to PHI
#117 - Key Log
#144 - Authorization for Release/Request of Information
#208 - Requisition Form
#235 - Petty Cash Fund
#295 - Invoice
#311 - Client Fee Temporary Exception Form
#337 - Log Sheets for Checks
#372 - Augusta Public Transit Bus Ticket Log
#378 - Contract for Residential Services
#388 - Prescription Pad (Augusta)
#389 - Prescription Pad (Thomson)
#390 - Prescription Pad (Wilkes)
#403 - Facsimile Cover Sheet
#415 - General Journal Voucher
#454 - Services Contract
#455 - Invitation to Bid
#472 - Private Home Care Staff Requirments Credible Evidence
#474 - Supervisory Visit
#478 - Employee Health Record
#534 - Authorized Charting Privileges Register
#535 - Network Access Request Form (NARF)
#544 - Request for Non-CMHC Employee/Provider Billing System Setup
#545 - Unicare Additions
#546 - SBHS ROA Sheet
#574 - Supply Order Form
#617 - Product Evaluation Request
#623 - Employee TB Skin Testing
#624 - Employee Verification of OSHA Training
#625 - Employee Health Report
#629 - Contractors Time Sheet
#630 - Payroll Hourly Time Sheet
#668 - Statement of Understanding and Receipt of Equipment
#709 - Staff Survey
#728 - SBHS Request for Accounting of Disclosures of Client Protected Health Information
#729 - SBHS Request to Restrict Protected Health Information
#730 - SBHS Request for Amendment Form
#732 - Log of Disclosures
#733 - Administrative Duty Officer
#734 - Transfer Sheet for SBHS Property
#735 - Policy and Procedure Review Schedule & Tracking Form
#737 - Request for Billing Correction
#738 - Check Transmittal Form
#744 - Carrier Verification Form
#751 - Internal Audit Form
#752 - EEO Complaint Form
#753 - Charged Party's Statement
#754 - Movement Information for Pay Vouchers
#757 - Risk Assessment for Activities
#770 - C&A Stakeholders Survey
#774 - Request for Access to the Attorney for CSB
#776 - Request/Approval for Community Education Activity
#799 - Dispute/Refusal to Pay Form
#836 - Check Request
#849 - Budget Allocation Form
#870 - SHBS Employee Subject to Drug/Alcohol Screening Notice
#871 - Hepatitis B Vaccine
#880 - Request for Use of SBHS Credit Card
#884 - Policy and Procedure Manual Index
#889 - Employee Travel Expense Statement
#913 - Risk Management Assessment Plan of Correction Report
#914 - Risk Management Register
#915 - Risk Mangement Register Summary
#933 - Code of Conduct and Code of Ethics Certification or Compliance
#935 - Field File Checklist
#941 - Rent Supplement Information Form and Disclaimer
#956 - Provider Enrollment Form
#962 - Performance Management Review Form for Hourly Staff
Clinical Record Format
#100 - Adverse Drug Reaction Report
#103 - Report of Contact
#106 - Physician's Orders
#137 - Antabuse Treatment Consent Form
#173 - Physical Assessment
#186 - Initial Assessment
#193 - Progress Notes
#198 - Nursing Assessment
#200 - Discharge Summary
#214 - Consent for Treatment
#215 - Adult Psychosocial Assessment
#216 - Psychosocial Assessment of Child/Adolescent
#218 - Medication Profile
#231 - Private Home Care, Client Rights, Responsibilites & Complaintes
#247 - Consumer Referral Form
#251 - Supportive Living Consumer Financial Record
#252 - Deposit for Conserved Funds Residential Services
#255 - Confidentiality of A&D Abuse Patient Records
#260 - Medication Administration Sheet
#273 - Client Complaint Form
#275 - Consent for Medication
#276 - Daily Production & Pay Rate Sheet
#282 - Abnormal involuntary Movement Scale (AIMS)
#285 - CSP: Inventory of Personal Property
#287 - Request for Withdraw from Conserved Funds
#293 - Permission to Monitor Self-Administration of Medication
#310 - Billing Ticket
#345 - Client Vacation Leave Request
#353 A - Electronic Daily Progress Note
#356 - Record of Medical Visits for Residential Consumers
#357 - Personal Care home Resident Information
#358 - Personal Care Homes Resident's Rights
#359 - Personal Care Home Admission Agreement
#361 - Pharmacy & Therapeutics Committee Request for Formulary Change
#383 - Client Data Information Sheet
#384 - Medication Sheet for Residential Program
#437 - Fair share Financial Agreement
#445 - Consent for Photograph
#448 - Family Support Services, Individual Reimbursement Ledger
#449 - Family Risk Factor Index Criteria
#459 - Family support Agreement
#460 - Client Complaint Documentation Form
#470 - Respite Referral/MH Supported Living Program
#471 - Private Home Care Admission Agreement
#472 - Private Home Care Staff Requirements
#473 - Personal Care Assistant (PCA) Training Checklist
#474 - Private Home Care Supervisory Visit
#479 - Sample Inventory
#482 - MR/DD Psychosocial History
#483 - Residential Services Progess Report
#486 - Medication Error/Discrepancy Report
#496 - Conserve Funds Consent
#557 - Monthly Pharmacy Audit Checklist
#557 A - Monthly Medication Storage Checklist
#558 - Medication Sheet
#622 - Client TB Skin Testing
#626 - Client TB Testing Summary
#631 - MH Residential Funding Determination Matrix
#632 - HIV Testing Summary
#638 - Progress Note
#642 A - Weekly Progress Note
#645 - Therapeutic Holding Tracking Report
#667 - Child & Adolescent Services Initial Assessment
#671 - HIV/AIDS Confidentiality Agreement
#676 - Client Infection Summary
#677 - Client Infection Summary by Infection Type
#678 - HIV Counseling & Testing Log
#679 - Confidential Testing
#686 - Clients Rights and Responsibilities
#688 - Individual Service Plan Progress Note
#689 - MR Day Services Monthly Progress Note
#710 - Your Satisfaction with our Services
#722 - Steps to Initiate Involuntary Outpatient Treatment
#723 - Management of the Environment of Care
#727 - Confidentiality Agreement
#731 - Notice of Privacy Practices/Acknowledgement Form
#740 - Referral Form - Adult Mental Health Rehabilitation Services
#741 - Residential Supports Attendance Record
#742 - Verification of Medical Appointment
#745 - GA TASC/Community Activity Documentation
#746 - Day Services Note
#748 - In House Labatory Screening
#749 - Individual Service Plan Review
#750 - Non-Billable Group Treatment Note
#755 - PPD Request for PCH Clients
#757 - Activity Documentation
#758 - Referral for C&A
#762 - Behavioral Events Summary
#763 - Referral Tracking Log
#764 - Medical Peer Review Form
#767 A - Subsequent Nursing Assessment/Care Progress Note
#771 - Assessment Update
#772 - Depo Provera Review
#779 - Day Support Assessment
#788 - CSI Authorization for Services
#789 - Transition Plan
#790 - Consent Form for HIV Confidential Testing
#791 A - IFI Progress Note
#795 - MR Chart Audit Form
#800 - Treatment Team Minutes
#801 - Confirmation of Errors in Documentation
#802 - Utilization Review Form
#803 - DD Clinical Chart Format
#808 - MR Residential Inclusive Community Activity Tracking Sheet
#844 - Substance Abuse Day Services Note
#844 A - Substance Abuse Day Services
#852 - Supported Employment Service Note
#853 - PRN/Over The Counter Medications
#854 - Transfer Sheet for Clinical Record(s) Movement Between Sites
#855 - Health Service Technician's Competency Checklist
#856 - Nurse's Competency Checklist
#860 - Medical Visit Report
#863 - CSI Maintenance Progess Note
#863 A - CSI-Medication Maintenance
#865 - C&A Assessment
#868-P - Advance Directive for Mental Health Care
#869 - Client Leave Request Form
#872 - Individual Progress Note
#899 - Maintenance Protocol for Patients on Atypical Antipsychotics
#906 - Field File Checklist for Private Home Care
#907 - MR/DD Services Private Home Care Service Plan
#908 - Private Home Care Skill Observation/Competency Checklist
