Common-Place Handbook General Assistance (GA) SSI Advocacy ... · •There have been repeated...

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Update #14-02 Revised: 02/07/14 Common-Place Handbook page 65-1 General Assistance (GA) SSI Advocacy 65. General Assistance (GA) SSI Advocacy The SSI Advocacy program was established in 1985 by the Board of Supervisors to assist disabled General Assistance (GA) clients. The ultimate goals are to obtain SSI and/or SSDI approval and provide assistance in obtaining Interim Assistance Reimbursement. The program utilizes Social Worker intervention to assist clients in following through with the SSI/RSDI application process, secure additional and more precise medical/psychiatric information, and provide representation at the various appeal levels in the SSI process. 65.1 CalWIN Referrals STAGE WHO TASKS/STEPS 1. Eligibility Worker Ensures that the following documents are in IDM: Initiates CalWIN On-line Referral if client meets the following criteria: •Client’s SSI claim has been denied at the Initial Level, or any other level. •There have been repeated denials of SSI for failure to follow through with the SSI process. •Client is unable to comply with the SSI appeals process. •Client has been on GA as unemployable for a year or longer. •"General Assistance - Request for Medical Information" (SCD 1400) including Attachment, "Consent to Release Social Services Records to SSI Advocacy Program Approved Attorneys". •Authorization for use and Disclosure of Protected Health Information Pursuant to HIPAA (SCD 1400A).

Transcript of Common-Place Handbook General Assistance (GA) SSI Advocacy ... · •There have been repeated...

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Common-Place Handbook page 65-1General Assistance (GA) SSI Advocacy

Update #14-02 Revised: 02/07/14

65. General Assistance (GA) SSI Advocacy

The SSI Advocacy program was established in 1985 by the Board of Supervisors to assist disabled General Assistance (GA) clients. The ultimate goals are to obtain SSI and/or SSDI approval and provide assistance in obtaining Interim Assistance Reimbursement. The program utilizes Social Worker intervention to assist clients in following through with the SSI/RSDI application process, secure additional and more precise medical/psychiatric information, and provide representation at the various appeal levels in the SSI process.

65.1 CalWIN Referrals

STAGE WHO TASKS/STEPS

1. Eligibility Worker

• Ensures that the following documents are in IDM:

• Initiates CalWIN On-line Referral if client meets the following criteria:

•Client’s SSI claim has been denied at the Initial Level, or any other level.

•There have been repeated denials of SSI for failure to follow through with the SSI process.

•Client is unable to comply with the SSI appeals process.

•Client has been on GA as unemployable for a year or longer.

•"General Assistance - Request for Medical Information" (SCD 1400) including Attachment, "Consent to Release Social Services Records to SSI Advocacy Program Approved Attorneys".

•Authorization for use and Disclosure of Protected Health Information Pursuant to HIPAA (SCD 1400A).

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STAGE WHO TASKS/STEPS

2 Clerical • Checks in the EW Referral basket or IDM Retrieval for completed “General Assistance - Request for Medical Information" (SCD 1400) signed by a physician, including "Consent to Release Social Services Records to SSI Advocacy Approved Attorneys" (SCD 1400 Attachment).

If there is... Then...

NO SCD 1400 Initiates TMT requesting a completed SCD 1400, including Attachment.

SCD 1400 without attachment

Initiates TMT requesting a completed SCD 1400 Attachment.

SCD 1400 with attachment in IDM or basket

Proceeds with the steps below.

• Identifies and assigns the case as follows:

If the case is... Then...

Previously assigned to SW but the case is in closed status

Note on the referral packet the name of the previous SW and open the case to X1AC.

Not known to Advocacy

Open the case to XIAC.

• Stamps the SSI Referral,

• Prints MEDS screens, completes information on stamped document and attaches the following MEDS screens to the Referral:

• INQX• INQP

• Forwards the SSI Referrals to the Social Work Supervisor.

Note:

• Manually files EW Referrals e-mails with attached SCD 1400 form by its referral month.

• Regularly provides SWS with EW SSI Referral Packet on a monthly basis as determined by SWS.

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Common-Place Handbook page 65-3General Assistance (GA) SSI Advocacy

STAGE WHO TASKS/STEPS

3 SW Supervisor

• Receives print outs from the CalWIN On-Line SSI Referral with attachments from clerical,

• Reviews the reason for the referral,

• Makes case annotations in the SSI Advocacy Application System, as appropriate,

• Sends e-mail to notify Social Worker (SW) of case assignment,

• Maintains screen prints without County Code 43.

Note: All cases in XIAC will be assigned to SW by chronological referral date.

4 Social Worker

Social Work Assessment Process

• Receives e-mail from Social Work Supervisor showing the case assignments.

• Reviews the referrals and documents (i.e. SCD 1400, MEDS screens, proof of citizenship and CalWIN Referral) in IDM.

• Ensures case is in "open" status and the contact information is correct.

• Reviews proof of citizenship (if applicable) for:

- Strength of external support (family, organization, legal representation, etc.)

- Date of entry to the United States, if not a U.S. Citizen

• Reviews IDM for additional documents (i.e. SSP 14, Interim Assistance Reimbursement)

• Makes initial assessment to determine whether the client needs assistance to apply for benefits. The Social Worker (SW) can use the "SSI Advocacy Unit Intake" form (SCD 1541), as a resource. The SCD 1541 will not be IDM processed.

• Sends appointment letter with date, time and location noted.

• Completes the following forms:

Reminder: Attach the California Meal Allowance form for claimants who are transient or don’t have cooking facilities.

Update #14-02 Revised: 02/07/14

•"Appointment of Representative" form (SSA 1696). Print "SCP" in front of Case Worker’s Name, if applicable.

•"Authorization to Disclose Information to the Social Security Administration" form (SSA 827). Claimant must sign and date the form.

•"SSI" Application form (SSA 8000). Include spouse’s SSN, if applicable.

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65.1.1 Director’s Exception Referrals

The Director of the Department may grant exceptions to the General Assistance (GA) policies to alleviate extreme hardship in emergency and unusual situations. A record of such exceptions shall be maintained by the Department. A decision by the Director on a request shall be final and not subject to appeal.

An Eligibility Worker (EW) or a Social Worker must evaluate the individual or family circumstances to determine if an extreme hardship exists. An extreme hardship exists when an individual or family does not qualify for any state or federal program and has no other income, resources or means of support.

STAGE WHO TASKS/STEPS

1 SW Initiates a Director’s Exception by completing the “Request for Director’s Exception” (GA 5) for disabled clients that need a specialized mental, health or medical evaluation from an outside provider:

• Completes the GA 5 referral justifying the needed funds for the request,

• Secures an estimate from the treating source and includes it on the GA 5,

• Sends the request to the Social Work Supervisor for review and signature,

• Documents in CalWIN Maintain Case Comments window.

2 SW Supervisor

Receives a Director’s Exception from a unit Social Workers:

• Reviews the case for accuracy of payment and to ensure that all necessary work has been completed,

• Signs the “Request for Director’s Exception” (GA 5),

• Forwards it to GA SSPM for approval.

4 GA SSPM Receives and immediately signs the “Request for Director’s Exception” (GA 5)

[Refer to “Director’s Exceptions,” page 11-1]

Revised: 02/07/14 Update #14-02

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65.1.2 Health and Hospital System (HHS) - Outstation Referrals

Since the inception of the Social Services Agency/HHS Valley Homeless Health Care Program (VHHP) in August 2009, SSI Advocacy Unit has outstation Social Workers to serve non-GA clients referred directly by treating physicians and psychiatrist in the following HHS sites:

• Central Wellness Benefit Center (CWBC)• Boccardo Reception Center (BRC)• Valley Homeless Clinic (VHC)

The following steps must be followed when processing Outstation Referrals

STAGE WHO TASKS/STEPS

1 Clinic Staff/ SSI Advocacy SW

• Screens client’s potential eligibility for SSI and determines if referral to SSI Advocacy is appropriate.

If... Then...

Referral is valid and client meets the SSI Advocacy criteria,

Refers client to SSI Advocacy via e-mail with assignment request.

Referral is NOT valid and client does not meet the SSI Advocacy criteria

• Do not refer client to SSI Advocacy,

• Determines if Medi-Cal application is appropriate.

2 SW Supervisor

• Receives and reviews the SSI Advocacy Outstation Referrals via e-mail,

• Assigns the case to designated Social Worker,

• Records the case assignment in the SSI Advocacy Application System,

• Sends e-mail to notify SW of case assignment.

• Oversees case assignments for the SSI Advocacy SW at VHHP.

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3 Social Worker

• Participates in the case conference with the HHS/SSA multi-disciplinary team.

•Serves as subject matter expert when clients are being assessed for SSI Advocacy.

•Takes lead in the discussion of current active SSI Advocacy cases.

•Updates team on the development of client’s SSI application.

• Meets with client and establishes a protective filing date with the Social Security Administration either by phone or in person.

• Completes the necessary forms and files them in the case folder.

• Identifies and provides access for client to obtain needed supportive services:

- Social Security card- State Identification- Birth Certificate- Transportation to appointments- Phone, or- P.O. Box or mailing address.

• Collects client’s medical records for evidence.

•Obtains release of information for all known medical records.

•Identifies the location of medical records for patients; reviews and copies medical records from Valley Medical Center (VMC), if applicable.

•Faxes the requests for records to other treating agencies and hospitals.

Outstaioned SWs at Valley Homeless Clinic (VHC) and Boccardo reception Center (BRC) must adhere to the following on-site procedures:

• Participates in regular case conferences to determine appropriate referral;

• Accesses all medical records at site;

• Assists GA and non-GA linked clients. (For BRC, assist non-GA linked Veterans with HHS medical practitioners assisting in obtaining VA medical records);

• Closes case upon SSI approval or as otherwise agreed upon at site case conference.

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STAGE WHO TASKS/STEPS

Social Worker

Outstationed SWs at Central Wellness and Benefits Center (CWBC) must adhere to the following on-site procedures:

Upon assignment of referral by Advocacy, SWS, CWBC staff complete an intake packet consisting of the attached SSI Advocacy referral and copy of Unicare On-Line Clinician Notes.

• Accesses all HHS medical records through VMC;

• Requests mental health records from designated CWBC staff and must return it to the chart room filing basket at the end of each day;

• Participates in regular case conference to update HHS shared drive list on client SSI case status, client engagement status (at next clinic appointment) and activity needed for SSI approval;

• Per CWBC rules, SSI Advocacy worker will close case if patient is not following through with treatment within 90 days of referral date;

• Closes upon information received from client at point of engagement (i.e., client refuses to apply for SSI, moved out of county, has other income or resources, or life insurance policy, etc...)

• Assists GA and non GA linked clients.

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3 Social Work Supervisor

• Visits both sites at Health and Hospital System (HHS) as needed to meet with the SSI Advocate SWs.

• Provides direction and consultation to SSI Social Worker.

• Meets with SSI Advocacy SWs as needed to discuss progress and time frames of the SSI Advocacy cases.

• Serves as Liaison/Subject Matter Expert (SME) between GA/SSA/SSI Advocacy unit and HHS.

• Develops collaborative relationships with the management of each site at HHS, including the Clinic Staff.

• Provides monthly report to HHS management, regarding approvals.

• Assists and participates in on-going business process discussion, revisions and documentation as needed.

• Reviews and monitors the following management reports on a regular basis to track the SSI Advocacy case assignments, monitor cases in development stage and to ensure that the SSI Advocacy cases and SSI Tracking System are updated:

- SSI Advocacy Application Stage and Count (e.g. SSI X16000 - Summary of Open SSI Referrals)

- Monthly IAR Report - General Assistance (e.g. IAR activity.)

- Any Ad Hoc or Management reports created for any other purposes.

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65.1.3 Data Match

STAGE WHO TASKS/STEPS

1. SSI Clerical • Prints out lists of pending GA clients from SSI Advocacy Application System, “Pending Caseload” (X1AC) and send it to the designated clinic staff on a monthly basis.

2. Clinic Staff • Reviews lists and identifies current mutual clients.

• Sends back e-mail to Social Work Supervisor with names of mutual clients.

3. SW Supervisor • Assigns the case(s) by its priority:

(1) Outstation E-mail Referral(2) Data Match(3) CalWIN On-Line Referral

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65.2 Case Assignment

65.2.1 SSI Application at Initial or Reconsideration Level

STAGE WHO TASKS/STEPS

1. Clerical • Gives the SSI Referral packet to the assigned SW.

2. SW • Discusses the option of having the Social Worker as the representative on the case rather than the attorney.

• Asks the client if he or she wants to send a withdrawal letter to the attorney.

If... Then...

Client agrees to work with the Social Worker,

• The case remains with the Social Worker.

• Social Worker follows the next appropriate steps in assisting client with their SSI application. Please refer to [Refer to “Director’s Exception Referrals,” page 65-4, Stage 4]

Client does NOT agree to work with the Social Worker,

• Close the case. Refer to [Refer to “Closings,” page 65-26]

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65.2.2 SSI Advocacy Case Denied at Reconsideration Level

STAGE WHO TASKS/STEPS

1. SW • Files an appeal with Social Security Administration (SSA) within 60 days of the SSA denial date, if client has not followed through with the attorney.

• Contacts the client.

• Refers the client to Santa Clara County’s list of attorneys.

• If necessary, attend the initial appointment with the client and attorney within a month.

• May serve as the liaison between the client and attorney until the case is closed.

• Sends closing e-mail to the Social Work Supervisor.

2. SW Supervisor

• Closes the case. Refer to [Refer to “Closings,” page 65-26]

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65.2.3 GA Recipient’s SSI Application at Hearing Level

STAGE WHO ACTION

1. Clerical • Gives the SSI Referral packet to the assigned SWS.

2. SWS • Assigns SSI Referral to SW.

3. SW • Contacts the GA client,

• Confirms if the client is represented by an attorney,

• If appropriate, discusses the option of having one of the attorneys in Santa Clara County’s list of attorneys to be the representative on the case,

• If appropriate, asks the client if he or she wants to send a withdrawal letter to the current attorney,

Note: If applicable, assists client in the transition of attorneys.

• Determines to keep case open or gives case back the case to the Social Work Supervisor.

4. SW Supervisor • Closes the case. Refer to [Refer to “Closings,” page 65-26]

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65.3 Unassigned Caseload

The following steps must be adhered to when the case is unassigned:

STAGE WHO TASKS/STEPS

1. Client or Attorneys • Calls or walks-in at GA Lobby to inquire on SSI Advocacy case status or to request resources.and/or information.

2. SSI/GA Clerical or SW OD

• Receives call or inquiry in person:

If it is received by... Then...

GA Clerical Screen call/inquiry and refer the call or lobby inquiry to SSI Clerical or SSI Officer of the Day/SW Supervisor.

SSI Clerical • IDs the client/case to ensure that the case is unassigned or pending (Caseload X1AC).

• Refers the call or lobby inquiry to SSI Officer of the Day.

SW OD • IDs the client/case to ensure that the case is unassigned or pending (Caseload X1AC).

3. SSI Officer of the Day

• Determines reason of the call or lobby inquiry for any appropriate action:

If the request is... Then...

Regarding case status, information or resources,

• Assists client, authorized representative or lawyer with their specific request.

To close the SSI Advocacy case because client’s SSI is approved,

• Notifies the SW Supervisor via e-mail requesting to close the case.

In need of diligent search/action,

• Notifies the SW Supervisor via e-mail requesting to assign the case to a SW.

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Reminder:Without a signed release of information on file, client information must not be released.

4. SW OD Documents action taken on the case on SSI Advocacy Application System. And in CalWIN Case Comments, if applicable.

5. SW Supervisor • Recieves e-mail notification and take action per SSI Officer of the Day’s recommendation.

STAGE WHO TASKS/STEPS

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65.4 Case Development/Maintenance

65.4.1 Application Stage-Initial SSI/SSDI Application

STAGE WHO TASKS/STEPS

1. Social Worker

• Makes initial assessment to determine whether the client needs assistance to apply for benefits. The Social Worker (SW) can use the “SSI Advocacy Unit Intake”, (SCD 1541) as a resource. The SCD 1541 will not be IDM processed

• [Refer to “SSI Application at Initial or Reconsideration Level,” page 65-10].

Completes the following forms:

• Appointment of Representative (SSA 1696 Form). Write down “SCP” in front of Case Worker’s Name, if applicable.

• Authorization to Disclose Information to the Social Security Administration (SSA 827 Form). Only claimant can sign the form and remember to date it.

• SSI Application (SSA 8000 Form).

- Obtains spouse’s SSN, if applicable, this will help SSA determine if the claimant is eligible for other benefits.

- Remember to attached the California Meal Allowance form for claimants who are transient or do not have cooking facilities.

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STAGE WHO TASKS/STEPS

2. Social Worker • Compiles client’s Work History information.

• Requests medical and other records through fax, mail, phone, or in-person.

• Continues gathering medical records and assessing client.

• Gathers psychological-sociological evaluation, personal and treatment history in narrative, include observations, assessment, and quotes from the individual.

• Completes the “Social Security Disability Application (SSA 16 on-line form.

• Completes Disability Report Form (i-3368 SSA on-line) as follows:

- Uses claimant’s mailing address and zip code.

- When case worker’s contact information is requested, please type “SCP” in front of case worker’s name, if it is a SCP case.

- Types name of medical facility with Vendor Code

- Assembles the application packet for submission to SSA

Note:

SSA Office is determined by the claimant’s mailing address. [Refer to “Social Security Administration (SSA) Zip Code Listing For Use with SCP Claims Only,” page 65-39]

The following steps must be adhered for Santa Clara County SSI Pilot (SCP) Program cases:

There are only two Social Security Offices processing the SCP cases:San Jose Downtown and East San Jose.

Fax paper SSA 8000, SSA 1696, SSA 827, SCP Cover Sheet, Referral To/From to SSA (SCD 169) and any immediate medical information to SSA:

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STAGE WHO TASKS/STEPS

Social WorkerSan Jose Downtown Fax# (408)535-5260Email address: [email protected]

or

East San Jose Fax# (408)291-4259Email address: [email protected]

• Mails original paper SSA 8000 and annotate SCP on the envelope to:

San Jose Downtown Office280 S. First Street, Room 244, San Jose CA 95113Attention: SCP

or

East San Jose Office 2500 Fontaine Rd.San Jose CA 95121Attention: SCP

Reminders:

If the paper SSA 8000 is not received, follow-up procedures to begin closing out the claim and effectuate a denial will begin.

DDS is required to obtain medical information from all sources listed on the i3368. You may also contact the assigned analysts at DDS to discuss medical information and possibly delay a Consultative Exam (CE) within a reasonable time period. [Refer to “Disability Determination Services (DDS) Directory,” page 65-41]

• Assists client in completing the most commonly forms sent by DDSD such as:

- Function Report - SSA 3373- Work History - SSA 3369- Third Party - SSA 3380

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- Pain Questionnaire- Exertion Questionnaire- Asthma Questionnaire

Note: If the form is not sent by Disability Determination Services Division (DDSD) Analyst and the SW determines that it is in the best interest of the client to submit one of these forms or other forms, the SW should do so.

• Fax any additional supporting documentation to DDSD Analyst. Client’s Social Security Number can also be used.

• Continues to gather information as needed and send it to DDSD analysts

• Completes the SSI Advocacy Application System. And completes the CalWIN Maintain Case Comments window, if applicable.

• Submits assessment, medical records, and any other necessary documents to clerical to be scanned into IDM.

• Documents actions taken in the SSI Advocacy Application System.

• Completes the necessary fields on the Collect Individual SSI/SSP Detail window and the [Advocacy and Hearing Details] tab.

• On the Maintain Case Comments window, selects Case Update from the drop down field and enter the description of actions taken (i.e. Initial SSI application filed 3/12/13).

• Determines if additional information is needed for SSI approval.

• Submits documentation for scanning.

Note: Time period for initial decision is 180 days.

• Social Worker reviews MEDS monthly and updates notes in the SSI Application System.

3. Clerical • Receives complete packet which includes:

- Assessment- Medical records, and- Any other necessary documents from Social Worker to scan

into IDM.

• Scans the received documents into IDM

STAGE WHO TASKS/STEPS

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65.4.2 Denials

65.4.3 Reconsideration (1st Appeal)

STAGE WHO TASKS/STEPS

1. Social Worker • Receives notification of SSI denial or a copy of denial letter.

• Schedules an appointment with client.

• Assists the client in following through with the next steps of the SSI application process. [Refer to Reconsideration of Denial or Administrative Law Judge Hearing]

• Secures additional and more precise medical/psychological information, if applicable.

• Provides assistance and/or representation at the various appeal levels.

• Completes the SSI Advocacy Application System.

STAGE WHO TASK/STEPS

1. Social Worker Receives information that the SSI Initial Application is denied and takes the following actions:

- Client must file an appeal within 60 days of the denial.

- Schedules an appointment with the client, as appropriate.

- Completes the necessary forms, or

- Submits any new medical or psychological information, if applicable

Note: The time period from an application to the decision can take up to 180 days.

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STAGE WHO TASK/STEPS

Social Worker If the client is... Then...

Approved, Documents in CalWIN Maintain Case Comments window and the SSI Advocacy Application System.

Denied, Must file another appeal within 60 days of the denial date.

Note: If client failed to appeal the SSI denial, it might result denial/discontinuance of GA case. The client remains ineligible until cooperation is achieved with all aspects of the process.

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65.4.4 Administrative Law Judge Hearing

STAGE WHO TASK/STEPS

1. Social Worker • Receives notification of the client’s SSI denial at Reconsideration level for active cases. Ensures that an appeal is filed, if appropriate.

- Reviews case to see if an appeal is warrant. Client must file an appeal within 60 days of the denial.

- Schedules an appointment with the client, as appropriate.

For newly assigned cased, start with the process below:

- Refers client to Santa Clara County’s list of attorneys.

- Assists client in scheduling appointment with the attorney.

- Provides any and all medical and psychological materials.

- If necessary, attend the client’s initial appointment with the attorney.

Note: If client has not secured an attorney or there is no follow-up, Social Worker should file an appeal and assist client in obtaining representation.

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65.4.5 Presumptive, TERI, or Compassionate Allowances - Conditions of Disability

STAGE WHOTASK/STEPS

1. cont. Social Worker When the Hearing decision is received, the SW must take the following steps:

If the client is... Then...

Approved, • SW must document in CalWIN Maintain Case Comments window and into the SSI Advocacy Application System when the SSI claim is awarded.

Denied, • The attorney determines the next level of appeal within 60 days of the denial date (at this stage the claimant might be asked to file a new SSI Claim.)

• The attorney files for different levels of appeal. These stages are completed by the assigned attorney with legal briefs. Must file legal brief on record.

Note: The time period from an application to the decision can be up to 12 months.

STAGE WHO TASK/STEPS

1. Social Worker • Determines potential presumptive eligibility based on Code of Federal Regulations (CFR).

• Documents in writing the justification for presumptive eligibility in “Disability Report-Adult” (i3368) and/or “Disability Report- Appeal” (SSA 3441)

• Completes application and files accordingly.

• Continues to monitor closely for ending of aid payments after 6 months of presumptive eligibility.

• Documents in CalWIN Maintain Case Comments window and the SSI Advocacy Application System.

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STAGE WHO TASK/STEPS

Social Worker If Disability Determination Services Division (DDSD) indicates client is...

Then explain to the client.

Presumptive Disabled, • The claim was approved and payment will be received.

• Aid payment will stop at the end of 6 months even if the DDS is still pending.

Not Presumptive Disabled,

• Case will remain pending for DDS decision.

• Client may need to reapply for GA benefits.

• When a decision is received take appropriate approval/denial action on the case.

Note: If the client is eventually denied, he/she will not have to pay back the benefits received under presumptive disability.

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65.4.6 In-House Psychological Evaluation

STAGE WHO TASK/STEPS

1. Social Worker • Makes a determination during the assessment process that the client needs a psychological examination.

• Schedules an appointment with the on-site psychologist via e-calendar.

• Gathers medical and psychological records.

• Completes the "Adult Intake Survey" form.

• Completes the "Interpreter/Translator Services Request Form" (SC 1257) if needed.

• Refers and forwards all of the above to the psychologist prior to the client’s appointment

• Documents action taken on the case on SSI Advocacy Application System.

2. Psychologist • Returns to the Social Worker the psychological report within 30 days following client’s appointment.

• Notifies Social Worker by e-mail or phone if evaluation report is not generated

3. Social Worker • Receives the psychological evaluation by e-mail

• Reviews and determines if the information received should be sent to Social Security Administration as part of evidence of record.

Notes:

- If specialized testing is not available to the client, refer to Director’s Exception Process [Refer to “Director’s Exceptions,” page 11-1

- Amended reports may be given to client upon request.

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65.4.7 Client Fails to Cooperate with SSI Advocacy Unit

Whenever a client fails to show up for his or her appointment or cooperate with the SSI Advocacy Unit, the following steps must be followed:

STAGE WHO TASK/STEPS

1. Social Worker • Sends a “Failure to Respond Letter” (GA 8) and gives client two (2) weeks to respond.

• Submits GA 8 to Clerical for IDM processing.

• Documents in CalWIN Maintain Case Comments and SSI Advocacy Application System,

• Sends e-mail to SSI Clerical to request a TMT to assign the case to EW for appropriate action.

• TMT date 30 days after GA benefits are discontinued.

GA must be discontinued if client is not cooperating with the SSI Advocacy Unit and is non-compliant with the GA agreement. [Refer to “Closings,” page 65-26]

If the client cooperates before the SW case is closed, sends TMT request to restore the case.

Note:

- Exceptions to these are to be discussed during the Social Worker’s monthly case conference with their Supervisors

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65.4.8 Closings

STAGE WHO TASK/STEPS

1. Social Worker

• Sends e-mail notification to SW Supervisor requesting to close the case.

• Documents in CalWIN Maintain Case Comments window and into the SSI Advocacy Application System when closing the SSI Advocacy Case. Entries must include:

•Reason the case is being closed*

•Date of SSI approval or denial under "Results" on the SSI window (i.e. Initial, Reconciliation, Hearing, Appeal Council)

•Level at which it was approved or denied (i.e. Initial, Reconciliation, Hearing, Appeal Council)

•Date of onset for approved case - Effective Date (when available).

*Cases may close for various reasons and may not always relate to an application filing.

2. SW Supervisor

• Receives e-mail from SW requesting to close the case.

• Reviews closed case in the SSI Advocacy System.

If... Then...

Discrepant, Sends e-mail to SW, with instruction for correction.

Clear and approves closings,

Enters comment into the SSI Advocacy Application System.

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65.5 Accessing and Completing the SSI Advocacy Application System

STAGE WHO TASKS/STEPS

1. Social Worker • Accesses the SSI Advocacy Application System by logging in as follows:

Step Action

1 • Type in username and password

• Click the [Login] button.

Reminder: The username and password is the same information used to log in at start up.

2 The My Referrals window appears with “Welcome, (Your Name).” It display the first 16 cases in alphabetical order and indicates if there are any alerts.

3 Clicks on the ID or Case Name to access case information. The Client Summary tab provides:

• Client’s identifying information.

• Referral information and stage of SSI application.

• Alerts can be added from this page.

4 The Profile tab is where the client’s general information is location (information can be entered or deleted) and is divided into four sections:

(1) Demographics

(2) Work & Legal

(3) Substance Abuse and Abuse

(4) Medical & Disability

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STAGE WHO TASK/STEPS

Social Worker

Profile Sections

1. Demographic page tracks family (children), education, prior aid and veteran status. To add additional entries and delete existing entries:

• Click on [Add New Entry] - a blank row will appear, or

• Click on [Reset] to Delete. The entry will be deleted from the page.

• Click [Save].

2. Work & Legal page tracks employment and legal history. To add additional entries and delete existing entries:

• Click on [Add New Entry] - a blank row will appear, or

• Click on [Reset] to Delete. The entry will be deleted from the page.

• Click [Save].

3. Substance Abuse and Abuse page tracks the client’s substance abuse and abuse history. To add additional entries and delete existing entries:

Step Action

1.Click on [Add New Entry]- a blank row will appear.

2. Click on the Type of abuse (there are seven types of abuse listed) from the drop down field.Complete the Explanation of the History of Abuse field.

3. Click [Save]. To save the information.

4. Click on [Reset] to Delete. The entry or existing entries will be deleted from the page.

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STAGE WHO TASK/STEPS

Social Worker 4. Medical & Disability page tracks the client’s medical history and disability information. Be sure to enter and copy the following in the Medical History:

• Enter the medications and diagnosis. • Copy the diagnosis into the Disability window.

5. Referral tab tracks the client’s open SSI referrals. If there is no referral for this client, a referral can also be opened from this page. There are two fields in this tab.

1) The Referral Information:

Who Completes...

Referral Information Sections to be completed...

Clerical Who created the referral.

Clerical Date of creation.

SW Supervisor Assignment.

SW Supervisor Date of Assignment

Clerical Source

Clerical Type and To

SW Supervisor Status

Social Worker Final disposition

2) The Application is where the SSI application is tracked and shows the following sections:

• Opened - refers to the date the application was filed (refers to the application for the following sections).

Note: Enter the date the new application (initial) was filed. This date does not change.

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STAGE WHO TASK/STEPS

Social Worker Step Action

Cont. 5 • Application Status- refers to how/what the application status is.

- Pending Externally - claim is pending. The client is represented by an attorney or CBP advocate or the case is not open to the SSI Advocacy Unit.

- Pending Internally - Claim is pending, the client is represented by the SSI Advocacy Social Worker, and

- Approved - claim is approved

- Presumptive - claim is approved as presumptive.

• Stage - refers to the application stage.

• Filed on - refers to the date of filing.

• Represented by - this can be the client, social worker, attorney or other representative.

• Result on - refers to the date the result was given/decision date on the MEDS QX, QP screens (i.e., the date on the denial letter or in some cases the date the social worker was notified.)

• Effective - refers to approved/on set date of application This should reflect the date that the payments will go back to or the date the SSA states the disability began. This date is retroactive to the onset date.

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STAGE WHO TASK/STEPS

Social Worker

Step Action

To... Action...

Add next stage or level of application,

• Click [Add New Stage For Application ____]

• Click on [Add New Application] if a new SSI claim has been initiated (i.e., appeal time lost and no grounds for “good cause” or SSI claim has been denied at the hearing and it’s been deemed that a new claim should be filed)

Keep the information

Click the [Save] button.

Delete, Click the [Reset] button. Reset will clear the screen.

6 Note tab is the Summary page that records all notes entered on the case. To read past Notes click on the Subject line. The following field headings are defined as follows:

• The date Created refers to the date that the notation was saved in the system.

• The Refers To date is the date that the interaction, letter, and etc. occurred

• The Author is the person signed into the system.

• The Subject provides a description of the note.

To... Action...

Enter a new Note,

• Click [Add Note]• Enter the Subject and Refers To

with the date the note was entered.• Complete the Note window the same

as completing the SC909.

Keep the information

Click the [Save] button.

Delete, Click the [Reset] button. Reset will clear the screen.

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STAGE WHO TASK/STEPS

Social Worker

7 Contacts tab shows a summary of contacts and a list of basic information about each contact.

Step Action

1 Click on the contact name to access detailed information. This page records contact information.

• The Author and Created fields are system generated.

• The Active section defaults to “Yes” if the contact becomes obsolete check as “No”

• The Type is selected from the drop down menu.

2 Enter at least the contact’s last name and any other identifying information.

3 Enter a note in the Note section if more details are required.

4 Click the [Save] button to keep the information.

5 Click [Reset] to clear the screen.

8 The Reminders tab is to enter upcoming dates that are important to the case, (i.e., meeting at SSA, meeting with an attorney or reconsideration is due.)

Step Action

1 Enter the Due Date manually or using the calendar.

2 Enter Remind Me the number of days you want to be reminded before the due date.

3 Enter the task into the Task window.

4 Click the [Save] button to keep the information.

5 Click [Reset] to clear the screen.

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STAGE WHO TASK/STEPS

Social Worker 9 Alerts

Step Action

1 Click on [Add Alert] from the Client Summary page. The Alerts will show up on the Client Summary page in red. Alerts are designed to get the attention of anyone entering the case.

2 Type the information in the Alert Details window>

Example: “Client needs to see assigned social worker to file Reconsideration.”

3 Click [Save]

4 Click [Reset] to clear the screen

2). The Find a Referral window allows searching for a referral by”

• Date• Social Worker assignment• Source• Type• Status• Application stage, or• Final Disposition.

Note: The best use of this page is searching by social worker assignment.

3) The Find a Client window allows searching for a client. The CalWIN case number will provide the fastest results. Other means of searching is by using the SSN, CWIN, Name, old CDS Case#.

Note: The SSI Advocacy Application System is an SSA Web Application and must be used for Tracking applications and to ensure accurate case load listings.

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65.6 Integrated Document Imaging (IDM)

STAGE WHO TASK/STEPS

1. Social Worker Takes documents that need to be scanned into IDM and places each document with the case # and SSN in the IDM baskets as labeled according to its category.

Note: IDM baskets are located in the SSI Unit area.

2. Clerical Checks documents placed in the IDM baskets on a daily basis and batches according to category and date and takes the following actions:

• Prepares documents for scanning by attaching the bar code header sheets and removing clips or staples.

• Scans each batch according to category into the IDM Capture System.

• Retrieves and verifies what was batched in the IDM Retrieval System.

• Stores the original batched documents that were scanned into IDM for 30 days in a designated area.

• After 30 days the original batched documents will be disposed.

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65.7 IDM Retrieval

STAGE WHO TASK/STEPS

1. Social Worker Retrieves documents by clicking the IDM Retrieval icon located on the desktop:

STEPS ACTION

1 Logs in using the date individual user Windows login ID and Password. The Search window appears.

2 Select a Search Template after logging into the application for the first time.

Note: The Search template is the default template that is displayed on the subsequent logins.

3 Click on the [Change Search Template] from the Search window. The Select Search Template appears.

4 Select from the two options either or both DEBS and SSI Search templates by clicking on the + expands the department and display the search templates available for each department such as Advanced Search or Basic Search.

1) SSI Advanced Search. The SSI Advanced Search template contains the same data fields as the DEBS Advanced Search template, except for the volume ID, Begin Date and End Date fields.

Step Action

1 Click [Search] after the search criteria has been entered the search results will be displayed.

2 For both the SSI Basic and Advanced Search templates, clicking on the Select Choice Sub Category [not selected] Select Choice line displays the list of SSI sub-categories.

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WHO TASK/STEPS

Social Worker Step Action

3 Retrieves all SSI and Benefits documents associated with an SSI case, the user leaves the Sub Category [not selected] Select Choice line on the Search window with the choice “not selected’.

4 Retrieves only the SSI documents associated with an SSI case, select the SSI-ALL option from the expanded sub-categories list.

5 Retrieves only the Benefits documents associated with an SSI case, select the BENEFITS - ALL option from the expanded sub-categories list.

6 Retrieves only one type of document associated with an SSI case (i.e., Medical Disclosures), select the type of document.

7 Selects a sub-category, left click on the sub-category name. The sub-category choice will be displayed in the search template window.

8 For both the Basic and Advanced Search templates, clicking Clear Choice reset the sub-category back to [not selected].

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65.8 Laptop Downloading/Retrieval of IDM Documents

WHO TASK/STEPS

Social Worker 2) SSI Basic Search:

Step Action

1 Click on at least of the data fields to search marked with a* in the SSI Basic Search template.

2 Clicking on the [Clear] button will delete any search criteria previously entered.

3 Clicking [Search] after searching criteria has been entered displays the search results. When the results are first displayed, they are sorted by sub-category and then by added on date within each sub-category.

STAGE WHO STEPS

1 Social Worker • Retrieves the necessary case documents using the IDM Retrieval applications

Step Action

1 The Search results will display.

2 Left click in the box located in first column of the search results row. This is done for each document that needs to be downloaded to the laptop.

3 Left click the box located to the left of the column Titles to select all the documents

4 Left click on the Download icon to start the download of the documents that have selected.

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Continuation Social Worker

5 A message will be displayed when the download process has been completed to inform that the documents have been downloaded to the local drive.

• Accesses the documents that been download into the laptop by:

Step Action

1 Click on My Computer

2 Click on the “C” Drive

3 Double Click to open the SSI cases folder

4 Click on the CalWIN Case Number - The CalWIN case number will be used to name the document folder.

• Retrieves the Saved documents by using the Chart below:

N Sub-Category Corresponds to IDM Display Name

1 Case Verif Case Verification

2 Corres Correspondence

3 Med Disc Medical Disclosure

4 App Applications/Appeals

5 Med Medical

6 Perm Verif Permanent Verification

7 F1 App F1 - Applications

8 F2 - Case Verif F2 - Case Verif/Child Support

Note: The Background process will delete the case folders containing the documents after 7 days.

STAGE WHO STEPS

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65.9 Social Security Administration (SSA) Zip Code Listing For Use with SCP Claims Only

OFFICE SERVICING ZIP CODES SEND PAPER DOCUMENTS TO:

San Jose 95002, 95014, 95015, 95050, 95051, 95052, 95053, 95054, 95055, 95056, 95101, 95103, 95106, 95108, 95109, 95110, 95112, 95113, 95115, 95117, 95125, 95126, 95128, 95131, 95134, 95150, 95155, 95157, 95159, 95161, 95164, 95172, 95190, 95191, 95192, 95193, 95194, 95196

San Jose Downtown:

Social Security Administration Room 244280 S First StreetSan Jose, CA 95113

Mountain View 94022, 94023, 94024, 94035, 94039, 94040, 94041, 94042, 94043, 94085, 94086, 94087, 94088, 94089, 94301, 94304, 94305, 94306, 94309

San Jose Downtown:

Social Security Administration Room 244280 S First StreetSan Jose, CA 95113

Milpitas

(Santa Clara County Zip Codes)

95035, 95036 San Jose Downtown:

Social Security Administration Room 244280 S First StreetSan Jose, CA 95113

East San Jose 95116, 95121, 95122, 95127, 95132, 95133, 95140, 95148, 95152, 95156, 95173

East San Jose:

Social Security Administration 2500 Fontaine Rd.San Jose, CA 95121

Campbell 95008, 95009, 95011, 95026, 95030, 95031, 95032, 95033, 95044, 95070, 95071, 95124, 95129, 95130, 95154, 95170

East San Jose:

Social Security Administration 2500 Fontaine Rd.San Jose, CA 95121

South San Jose 95042, 95111, 95118, 95119, 95120, 95123, 95135, 95136, 95138, 95139, 95141, 95151, 95153, 95158, 95160

East San Jose:

Social Security Administration 2500 Fontaine Rd.San Jose, CA 95121

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65.10SSI Contacts

65.10.1 SSI Advocacy SSA Field Office Directory

Note:Liaisons may change without notice.

Gilroy/Morgan Hill Area

(Santa Clara County Zip Codes)

95013, 95020, 95021, 95037, 95038, 95046

East San Jose:

Social Security Administration 2500 Fontaine Rd.San Jose, CA 95121

OFFICE LIAISON BACK-UP SUPERVISOR

San Jose Downtown Field Office

280 S. First St. San Jose, CA 95113

(Technical Matter/Case Specific)

Kunthea King(866) 331-2305Ext. 15942

Shahanaz Najafiaghdam(866) 331-2305Ext. 15929

Janette Kallman (866) 964-7276Ext. 15941

East San Jose Field Office

(Technical Matter/Case Specifics

Irene Aldape-Percelle(866) 572-9739Ext. 17414 Fax: (408) 291-4259

Hollie Huynh (866) 572-9739Ext. 17404 Fax: (408)291-4259

Hollie Huynh(866) 572-9739Ext. 17407 Fax: (408)291-4259

Area Director’s Office (ADO)

(Administrative)

Linda ZamfinoADO Supervisor(877) 700-4842Ext. 18174

Lucy ChinArea Operations Analysts(877) 700-4842Ext. 18180

Linda ZamfinoADO Supervisor(877) 700-4842Ext. 18174

OFFICE SERVICING ZIP CODES SEND PAPER DOCUMENTS TO:

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65.10.2 Disability Determination Services (DDS) Directory

65.10.3 Most Common and Frequent Medical Providers for Medical Information

OFFICE LIAISON BACK-UP

Administrative Matters

May XiongPrimary Contact(559) 440-5096

Elaine Hendrix Back-up (559)440-5089

Kari Vang Back-up(559) 440-5009

Michael MartinActing Manager(559) 440-5013

Technical Matters Rachelle Gabriel(559) 440-5039

Jennifer Lopez(559) 440-5314

Patricia Feller(559) 440-5037

Martin Wragg(559) 440-5329

Agency Service Address Phone Remarks

Valley Medical Center

(CO/H/Santa Clara Valley)

K021454

Medical 751 S Bascom Ave San Jose, CA 95128

(408)885-5000 (408) 885-3764

Valley Health Center at East Valley

(CO/C/Santa Clara East Valley)

K031782

Medical 1993 McKee Rd San Jose, CA 95116

(888)-334-1000(408)254-6369

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Valley Health Center at Milpitas

K056050

Medical 143 N. Main St. Milpitas, CA 95035

(888)334-1000

Valley Health Center at Gilroy

(CO/C/Santa Clara Health Center)

J193008

Medical 7475 Camino ArroyoGilroy CA 95020

(408)852-2205

Valley Health Center at Gilroy

(CO/M/Santa Clara Mental Health

J210426

Mental Health

7475 Camino ArroyoGilroy CA 95020

(888) 334-1000 (408)852-2400

Valley Health Center at Silver Creek

(CO/C/Santa Clara Valley Health Ctr at Silvercreek)

K056050

Medical 1620 East Capitol ExpwySan Jose, CA 95121

(888) 334-1000(408)494-7511

Valley Health Center at Tully

(CO/C/Santa Clara Valley Health Center)

J132355

Medical 500 Tully RdSan Jose CA 95111

(888) 334-1000(408)817-1447

Valley Health Center at San Martin

J193008

Medical 90 Highland Ave (408) 852-2205 Facily closed 10/08. Records should be requested from Valley Health Center at Gilroy.

If records are more than 2 years old, request should be directed to Valley Medical Center (Vendor # K021454)

Agency Service Address Phone Remarks

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Valley Health Center at San Martin

(CO/M/Santa Clara Alcohol & Drug Services)

S067280

Mental Health

90 Highland AveSan Jose, CA

(P.O. Box 717 San Martin, CA 95046)

(888)334-1000(408)683-4053

Valley Health Center at Moorpark

(CO/C/Moorpark Health Center)

K047997

Medical 2400 Moorpark Ave San Jose, CA 95128

(Requests sent directly to Santa Clara Valley Medical Center at 751 S. Bascom Ave)

(888)334-1000(408)885-5125

Valley Health Center at Lenzen

(CO/C/Santa Clara Public Health)

J209342 & K041692

Medical 976 Lenzen Ave # 1800San Jose, CA

(888)334-1000(408)885-4214(408)792-5187

Valley Health Center at Sunnyvale

(CO/C/Santa Clara Valley Health)

K054712

Medical Physical address:660 S Fair OaksSunnyvale, CA 94086

(408)885-3763 Request address:

751 S Bascom AveSan Jose, CA 95128

Valley Health Center at Sunnyvale

(CO/M/Santa Clara/Mental Health)

K039822

Mental Health

660 S Fair OaksSunnyvale, CA 94086

(888)334-1000(408)992-4800

Agency Service Address Phone Remarks

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Valley Homeless Clinic at Alexian

J207807

Medical 2101 Alexian Dr.Ste. DSan Jose, CA 95116

(408)272-6050

Stanford Medical Center

K015839

Medical 300 Pasteur Dr.Palo Alto, CA 94530

(650)723-5721 Records now housed at:

450 Broadway St. Room C14Redwood City, CA 94063

Kaiser Permanente Santa Teresa

K022451

Medical 250 Hospital ParkwaySan Jose, CA 95119

(408)972-3000

Kaiser Permanente Santa Clara/Homestead

J156191

Medical 710 Lawrence ExpwyDept. 160 1st FloorSanta Clara, CA 95051

(408)851-1000(408)851-1750

Kaiser Permanente Santa Clara/Psych

K027119

Mental Health

710 Lawrence ExpwyDept. 160 1st FloorSanta Clara, CA 95051

(510)741-1980

Veteran’s Administration Medical Center

(VA/San Jose/CBOC/Great Oaks)

K034277

Medical Physical address:

80 Great Oaks Blvd.San Jose, CA 95119

(408)363-3000(925)373-4700

Request address:

4951 Arroya RdLivermore, CA 94550

Veteran’s Administration Medical Center

(VA/Palo Alto/Miranda Ave Site)

K054500

Medical Physical address:

3801 Miranda AvePalo Alto, CA 94304

(650)493-5000(925)373-4700

Request address:

4951 Arroya RdLivermore, CA 94550

Agency Service Address Phone Remarks

Revised: 02/07/14 Update #14-02

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St. James Health Center

K034209

Medical 55 E. Julian St.San Jose, CA 95112

(408)918-2600

Gardner Health Center

K011759

Medical 195 E. Virginia St.San Jose, CA 95112

(408)918-5500

Indian Health Center of Santa Clara Valley

K021416

Medical 1333 Meridian AveSan Jose, CA 95125

(408)445-3400(408)445-3415

Mayview Community Health Center-PA

K035963

Medical 100 N. Moffett Blvd., Suite 101Mountain View, CA 94043

(650)963-3323

Mayview Community Health Center-CNC

J143927

Medical 785 Morse AveSunnyvale, CA 94085

(408)746-0455

CompreCare Health Center

W049167

Medical 3030 Alum Rock AveSan Jose, CA 95121

(408)272-6300

El Camino Hospital

K047160

Medical 2500 Grant RoadPark Pavilion BuildingMountain View, CA 94040

(650)988-7462

Rotacare Free Clinic

K056415

Medical 2400 Grant RoadMountain View, CA 94040

(650)988-8200

South County Community Health Center

K070521

Medical 1798A Bay RoadEast Palo Alto, CA 94303

(650)330-7400 Aka:

Ravenswood Family Health Center

Agency Service Address Phone Remarks

Update #14-02 Revised: 02/07/14

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Planned Parenthood Blossom Hill

K055580

Medical 5440 Thornwood Dr., Ste. GSan Jose, CA 95123

(408)281-9777

Planned Parenthood Eastside

K051288

Medical 3131 Alum Rock Ave.San Jose, Ca 95127

(408)729-7600

East Valley Community Clinic

K011598

Medical 2470 Alvin Avenue, Suite 80San Jose, CA 95121

(408)274-7100

Planned Parenthood The Alameda

F046728

Medical 1691 The AlamedaSan Jose, CA 95126

(408)287-7526

Parole Clinic(BAART)

K046007

Medical 909 Coleman AveSan Jose, CA 95110

(408)277-1821(408)277-1825

Fremont Hospital

J045154

Medical 39001 Sundale DrFremont, CA 94538

(510)574-4827(510)796-1100

Elmwood(Jail/Santa Clara County)

W049483

Medical 701 S Able St.Milpitas, CA 95035

(408)957-5832(408)808-5223

Health Record Center (CDC)

J170755

Medical P.O. Box 4038Sacramento, CA 95812

(8300 Valdez AveSacramento, CA 95828)

Phone:(916) 229-1475

Fax# (916)229-0608

Regional Medical Center of San Jose

D066964

Medical 225 N Jackson AveSan Jose, CA 95116

(408)947-2500

Agency Service Address Phone Remarks

Revised: 02/07/14 Update #14-02

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O’ Connor Hospital

F022140

Medical 2105 Forest AvenueSan Jose, CA 95128

(408)947-2500

Good Samaritan Hospital

K050909

Medical 2425 Good Samaritan DriveSan Jose, CA 95124

(408)559-2011(408)559-2380

Narvaez Mental Health

(CO/M/Santa Clara Mental Health-Narvaez

K025560

Mental Health

614 Tully RdSan Jose, Ca 95111

(408)299-4734(408)494-1561

Emergency Psychiatric Services

(CO/,/Santa Clara Mental Health Services)

K060531

Mental Health

871 Enborg Ct.San Jose, CA 95128

(408)885-6100

(408)885-6122

Aka:

The Don Lowe Pavilion

Sunnyvale Community Counseling Program

K060245

Mental Health

572 Dunholme WaySunnyvale, CA 94087

(408)524-4900

The Center for Healthy Development

K061216

Mental Health

100 N. Winchester Blvd. Suite 260Santa Clara, CA 95050

(408)985-8111

Ellyn D. Herb, PhD Health Psychology Associates

J226313

Mental Health

1475 S Bascom Ave, Suite 211Campbell, CA 95008

(408)369-1139

(408)296-9600

Address in vendor file:

1101 Winchester BlvdSte. M258San Jose, CA 95128

Agency Service Address Phone Remarks

Update #14-02 Revised: 02/07/14

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Asian Americans for Community Involvement

K047695

Mental Health

2400 Moorpark Ave, Ste. 300San Jose, CA 95128

(408)975-2730

Central Wellness & Benefits Center

(CO/M/Santa Clara Mental Health Ctr)

K037294

Mental Health

2221 Enborg LaneSan Jose, CA 95128

(408)885-6220

Heritage Psychiatric Health Center (Telecare/Oakland/Heritage Psychiatric Ctr

J139284

Mental Health

2633 East 27th Street Oakland, CA 94601

(510)535-5115

Phuong-Thuy Le

J180518

Mental Health

200 Jose Figueres Ave, # 250San Jose, CA 95116

(408)259-6022

Nhi Huynh

K011115

Mental Health

614 Tully RoadSan Jose, CA 95111

(408)299-4734 Santa Clara Valley Narvaez Mental Health Center

Dat Huynh

K011118

Mental Health

1661 Burdette Dr.Suite NSan Jose, CA 95111

(408)270-4582

Agency Service Address Phone Remarks

Revised: 02/07/14 Update #14-02