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(Print Legibly)Alameda County Behavioral Health Care Services Mental Health DivisionOpenCloseUpdateCLIENT EPISODE SUMMARY1 Client Name: Last First MI: Confidential Patient Information2 Client Numbers

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Open the client information form or document.

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Anyone who is collecting or managing client information, such as administrative staff, customer service representatives, or legal professionals, may need to fill out 1 client name last. This information is important for identification and record-keeping purposes.

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1 client name last is the last name of the first client.

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Only the last name of the first client must be reported on 1 client name last.

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