Presumptive Transfer (AB1299)

To provide children and youth in foster care, who are placed out of county of original jurisdiction access to Specialty Mental Health Services in a timely manner a prompt transfer of the responsibility for the provision of, or arranging of payment for services from the county of original jurisdiction to the county in which the foster child resides please contact:

For questions on Presumptive transfer process in Madera County please email BHSmentalhealthplan@maderacounty.com. Documents with Protected Health Information (PHI) must be encrypted as it is not a secure email address the single point of contact is Maria Mendoza, Senior Program Assistant, (559) 673-3508.

For Presumptive transfers please fax the following information to 559-675-7758;

• Name, location and contact information of placement agency
• Date of placement
• Childs DOB, name and current address
• Name and contact information of who can sign releases of information
• Name and contact information of who can sign consents
• Most recent Mental Health consent for services and JV 220 if appropriate
• Most recent Mental Health records including most recent assessment and treatment plan
• Court orders
• General Authorization to Use & Disclose Protected Health Information (one for the Foster Parent and one for the Foster Family Agency)
• Consent for Evaluation and/or Treatment of a Minor