Mental Health Diversion Provider Agreement {PAMHD}

PAMHD - PROVIDER AGREEMENT FOR TREATMENT REPORTING FOR MENTAL HEALTH DIVERSION. This form is used by a treatment provider or organization to commit to regularly reporting a client’s progress in their Mental Health Diversion program to the San Mateo County Superior Court. By signing the agreement, the provider agrees to submit progress reports at least five days before each scheduled court review, with the review dates provided by the client’s defense counsel. The provider also agrees to promptly inform the court of any significant changes regarding the client’s treatment, such as deviations from the treatment plan, non-compliance with medication or therapy, referrals to higher levels of care, or recommendations for conservatorship. The provider commits to notifying the court if the client withdraws or waives their HIPAA privacy rights. This information may be communicated through progress reports or other appropriate written forms, regardless of the regular reporting schedule. The provider confirms receipt of the client’s charging papers, which are provided by the client or defense counsel. www.FormsWorkflow.com