BILLING FORMS:

• Cost/Line Item Reimbursement (Excel File)
• Cost/Line Item Reimbursement (PDF)
• Staff Hours  (Excel File)
• Staff Hours  (PDF)
• Medi-Cal/Methadone Reimbursement  (Excel File)
• Medi-Cal/Methadone Reimbursement  (PDF)
• Fee for Service / Residential and Non-Residential  (Excel File)
• Fee for Service / Residential and Non-Residential  (PDF)
• Fee for Service / Residential and Non-Residential Section V (Excel File)
• Fee for Service / Residential and Non-Residential Section V (PDF)
• Cost Report (Excel File)
• Cost Report (PDF Files)
  • Summary Page
  • Schedule 1 pg. 1
  • Schedule 1 pg. 2
  • Schedule 2
  • Schedule 3
  • Schedule 4 pg. 1
  • Schedule 4 pg. 2
  • Schedule 5
  • Instructions

• Cost Report - Outpatient Drug Free  (Excel Files)
• Cost Report - Outpatient Drug Free (PDF Files)
  • Summary Page
  • Schedule 1 pg. 1
  • Schedule 1 pg. 2
  • Schedule 2
  • Schedule 3
  • Schedule 4 pg. 1
  • Schedule 4 pg. 2
  • Schedule 5
  • Instructions

Note:  The electronic file is provided by the County for convenience only.  The County does not represent or endorse the accuracy, current ness, or reliability, of any advice, opinion, instruction, statement, or other information displayed, downloaded, or distributed through the DHS Web Site.