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Placer County, CA
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  • Jobs, Benefits, and Business

    Includes veterans' benefits, starting and running a business, unemployment, County job openings, and selling to the County.

  • Law and Justice

    Includes the courts, most wanted, law enforcement, child support enforcement, sealing record, victims' services, and jury duty.

  • Building, Property, and Home

    Includes planning, building codes and permits, owning and renting a property, and property tax assessments.

  • Health and Family Care

    Includes child and adult health service, food stamps, foster care, mental health, in-home nurse, substance abuse, and child support.

  • Birth, Death, and Marriage

    Includes bereavement, certificates and vital records, and divorce.

  • Environment and Agriculture

    Includes air quality and burn days, garbage and recycling, sewer, conservation, and green energy financing.

  • Animal Services

    Includes adopting a pet, animal control, and local vets and shelters.

  • County and Government

    Includes information on the buildings, county, codes, departments, projects, representation, and voting.

  • Community and Recreation

    Includes activities and events, parks, museums, libraries, and volunteerism.

  • Taxes and Financial Reports

    Property taxes, business taxes, transient occupancy taxes, fines, and financial reports.

  • Transportation and Travel

    Includes passports, bus schedules, and road maintenance.

  • Safety and Emergency

    Includes forest fires and floods, emergency preparation, and emergency response.

Network Provider Forms

Form Number and Description

  • Provider Initial Assessment Forms Bundle - Bundle of forms includes the CARE 010, CARE 011, CARE 015, CARE 015a, CARE 015e, CARE 024, CARE 036 and HIPAA 05 (282KB)
  • Care 008 - Unified Service Plan (40KB)
  • Care 008e - Unified Service Plan (This form is to be downloaded and used as a Template) (236KB) Updated 08/05/2004
  • Care 009 - Request for Authorization / Treatment Plan Report to be printed and filled in by hand (29KB) Updated 07/10/2009
  • Care 009e- Request for Authorization / Treatment Plan Report (This form is to be downloaded and used as a Template) (254KB) Updated 07/10/2009
  • Care 010 - Data used to track Child treatment outcomes or treatment planning (65KB)
  • Care 011 - Data used to track Adult treatment outcomes or treatment planning (66KB)
  • Care 015 - Required Biopsychosocial Assessment (57KB)
  • Care 015e - Required Biopsychosocial Assessment (This form is to be downloaded and used as a Template) (303KB) Updated 4/22/2014
  • Care 015a - Completed with the Care 15, contains CSI data and cultural services (76KB)
  • Care 020 - English version Appeal/Grievance Form used for both clients and providers to file a complaint (15KB) Updated 12/11/2013
  • Care 020sp - Spanish version Appeal/Grievance Form used for both clients and providers to file a complaint (14KB) Updated 12/18/2013
  • Care 024 - Contains required CSI data (78KB)
  • Care 036 - Consent to treat a minor (13KB)
  • Care 041 - Systems of Care Progress Note (13KB)
  • Care 041e - Systems of Care Progress Note (This form is to be downloaded and used as a Template) (43KB) Updated 02/27/2009
  • Care 041ge - Systems of Care Group Progress Note (This form is to be downloaded and used as a Template) (53KB) Updated 09/05/2008
  • Care 141e - Child/Youth Biopsychosocial Assessment (This form is to be downloaded and used as a Template) (556KB) Updated 07/18/2012 (REV. 06/08/2012)
  • Care 441 - Psychiatric Consultation Request Adult Medi-Cal Beneficiaries (This form is to be downloaded and used as a Template) (37KB) Updated 11/18/2010
  • HIPAA 05 - Required when communicating with others regarding a client (410KB)
  • CPT/HCPCS CODES - Schedule of Contracted Rates Using Standardized CPT/HCPCS Codes (15KB)
  • CMS-1500 - This is only an example, the areas in yellow should be filled in on the CMS-1500 (141KB)
  • Beneficiary Protection English - Required Provider Posting Materials for Beneficiary Protection in English (250KB) Updated 12/11/2013
  • Beneficiary Protection Spanish - Required Provider Posting Materials for Beneficiary Protection in Spanish (304KB) Updated 12/18/2013
  • DSM-IV-TR to ICD-9-CM Crosswalk - DSM-IV-TR to ICD-9-CM Crosswalk, ICD-9-CM Fifth-Digit Descriptions and Criteria, and Global Assessment of Functioning (GAF) Scale (1.5MB)
  • Tax Forms - County of Placer required Tax Forms (114KB) Updated 1/28/2013
  • 2014 Provider Manual - 2014 Provider Manual (1.2MB) (revised 01/01/14)
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