Clinical Forms for Reviewing over the Internet.
While our HIPAA Policy has always been available online, we added the additional forms on this website during the 2020 Stay at Home Order so that individuals receiving services over telehealth or telephone could have access to viewing these forms.
HIPAA Policy
Portia Bell Hume Behavioral Health and Training Center (The Hume Center) is committed to maintaining the privacy of your protected mental health information, which includes information about your mental health condition and the care and treatment you receive from The Hume Center. The creation of a record detailing the care and services you receive helps our office to provide you with quality health care and is also required by law. Our HIPAA Policy details how your "Protected Health Information" (PHI) may be used and disclosed to third parties and also details your rights regarding your PHI.
Please click this link to view, print, or save this documentt. HIPAA PRIVACY NOTICE.pdf
Alameda County Informing Materials
For clients receiving services in Alameda County. Alameda County Mental Health Plan has provided this this packet of informingmaterials that explains your rights and responsibilities.
Please click this link to view, print, or save this documentt. INFORMING MATERIALS -- ALAMEDA COUNTY
Contra Costa County Informing Materials
For clients receiving Medi-Cal services in Contra Costa County. Contra Costa Behavioral Health has provided this this packet of informingmaterials that explains your rights and responsibilities.
Please click this link to view, print, or save this documentt.
CCHS Beneficiary Handbook 2018
CCHS Beneficiary Guidebook in Spanish 2018
Informed Consent
This document contains all the important information you need to know as you begins services and about your provider's status.
Please click this link to view, print, or save this documentt. INFORMED CONSENT.PDF
Telehealth Informed Consent
This document contains all of the additiuonal information you need to know before starting services over telehealth.
Please click this link to view, print, or save this documentt. TELEHEALTH INFORMED CONSENT.PDF
Release of Information Authorization
This document is what is used for a client to allow their provider to exchange information to or from someone else or a program.
Please click this link to view, print, or save this documentt. RELEASE OF INFORMATION.PDF
Patient's Rights
This document outlines the rights we believe our clients deserve and that we aspire to uphold at all times.
Please click this link to view, print, or save this documentt. PATIENT'S RIGHTS.PDF
Description of Services
This document includes important information about our programs. Call one of our clinics for the most up to date information.
Please click this link to view, print, or save this documentt. DESCRIPTION OF SERVICES.PDF
Grievance Policy and Grievance Form
Our grievance policy outslines the steps to take if you feel you have a grievance about a Hume Center staff member or service. Please click this link to view, print, or save this documentt. GRIEVANCE POLICY.PDF
This grievance request form should be filled out and submitted to a Hume Center clinic in order to file your grievance. Please click this link to view, print, or save this documentt. GRIEVANCE REQUEST.PDF