San Mateo — Proposition 36 (2024) Referral Form

Source: https://sanmateo.courts.ca.gov/system/files/local-forms/proposition-36-2024-referral-form.pdf

San Mateo County Superior Court Initial Referral for Screening for Proposition 36 “CONFIDENTIAL PATIENT INFORMATION: (2024) See California Welfare and Institutions Code Section 5328”

Proposition 36 (2024) creates a new process for defendants charged with drug-related charges to connect to mental health and substance use treatment in lieu of jail time. If defendants agree to participate, they are referred for a mental health assessment, substance use assessment, and, if necessary, a Medi-Cal eligibility evaluation. The defendant must agree to participate and complete a treatment plan, which may include but is not limited to drug treatment, mental health treatment, job training and any other conditions the court finds appropriate.

The criterion for eligibility includes: • The participant consents to treatment and agrees to complete their treatment plan • They are charged with 2 or more prior drug-related offenses • They are suitable for substance and/or mental health treatment

The court has ordered the individual listed below to connect to a local provider for assessment and development of a treatment plan. Please complete the appropriate initial placement screening and information in Section B and return it to the defendant and/or their attorney at the address listed below as soon as possible. Follow up to this process can be done by contacting the individual’s attorney.

SECTION A: (To be completed by defendant/defendant’s attorney. Please email to hs_bhrs_rtxteam@smcgov.org with “Prop36 Referral” in the subject line upon completion.)

Defendant’s Name Defendant’s Attorney

Defendant’s Contact Information Attorney’s Contact Information
__________________________________
Court Case #’s Court Case #’s

Date of Birth In custody: Yes No

Pending charges Today’s Date: ____________

Next Court Date: _____________
Referred by:
Self-report Has Medi-Cal? Yes No
Superior Court of ________________
AOD Program ___________________ If yes, county of coverage: _______________
Probation_______________________
Parole _________________________ If no, eligible? Yes No
Defendant’s Attorney_____________
Other __________________________ If no, privately insured? Yes No

Copies to: Private Defender Panel or Defendant’s Attorney Yes No

Release of information attached: Yes No Has/will client enter(ed) a plea: Yes No Page 2 to be completed by accepting program.

Last Revised 5.9.2025

SECTION B: (To be completed by treatment provider. Email to PDP and hs_bhrs_rtxteam@smcgov.org with “Prop 36 Referral” in the subject line upon completion.)

SUD or MH Treatment Program: ______________________________________________________

Intake/enrollment Date: _______________________

Start Date: ____________________

Release of information attached: Yes No

Assessment and/or Treatment Plan attached: Yes No

Assessment Completed: Yes No

If yes, date completed: ___________________________

Treatment Plan Estimated Completion Date: _____________________________

Last Revised 5.9.2025