LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 300.03 Clinical Correspondence Concerning Clients
 
Policy Category:  Clinical
Distribution Level:  Directly Operated 
Responsible Party:  Quality Assurance
 
Approved by Debbie Innes-Gomberg, Ph.D., Deputy Director, Feb 07, 2025
I.  PURPOSE
 
To establish a uniform policy for staff of the Los Angeles County Department of Mental Health (DMH) directly operated programs when responding to requests for clinical correspondence to clients or on behalf of clients.
 
II.  DEFINITIONS
 
DMH Client:
  • Active DMH Client: An individual with an open DMH episode and has not had services terminated per DMH Policies 312.01 and 312.02.
     
  • Inactive DMH Client: An individual with no open DMH episode or whose services have been terminated per DMH Policies 312.01 and 312.02.
Clinical Correspondence: A document created by DMH clinical staff that is based upon documentation contained in a client's Clinical Record for the purpose of transmission to an active or inactive client or an outside agency or individual, and is NOT completed in the context of an inter-agency agreement for specialized clinical consultation.
 
III.  POLICY
 
DMH clinicians shall only respond to requests for correspondence concerning any person who is an active or inactive DMH client.

The information provided in the clinical correspondence must be factual, based on information clearly documented in the clinical record (Defined in Policy 401.02), and contain only information that is clearly requested. Information provided must have been obtained as a necessary part of the clinical assessment and/or treatment of the client's mental health condition.
  • Any clinical assertions expressed in the correspondence shall be clearly based upon information contained in the record.
Copies of any clinical correspondence must be retained as correspondence in the DMH Clinical Record.
 
IV.  PROCEDURES
 
Procedures - Clinical Correspondence Concerning Clients
 
V.  AUTHORITY
 
DMH Administrative Directive
 
VI.  ATTACHMENT