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Please note that the following forms may have new web addresses. Web pages or other documents that link to these forms may need to be updated.
 DHS-2727-ENG
Long-Term Services and Supports Assessment and Program Information and Signature Sheet
DHS-3642-ENG
Emergency Medical Assistance - Care Plan Certification Request
DHS-3932-ENG
Limited General Dentist Assurance Statement
DHS-4457-ENG
Request for Department Resolution of Financial Responsibility Dispute
DHS-4676-ENG
MHCP Inpatient Hospital Authorization Form
DHS-4695-ENG
MHCP Authorization Form
DHS-4797A-ENG
Determination of Ineligibility for Behavioral Health Home (BHH) Services
DHS-4797B-ENG
Behavioral Health Home (BHH) Services Rights, Responsibilities and Consent
DHS-4797C-ENG
Authorization for Release of Protected Health Information - Behavioral Health Home Services
DHS-6054-ENG
Signed Personal Statement about Assets for MFIP, DWP, GA, MSA and GRH Programs
DHS-6633A-ENG
CDCS Community Support Plan Addendum with 2016 Provider Rate Increase
DHS-6762B-ENG
Emergency Protective Services Intake Assessment Screening Decision Tool
DHS-6762C-ENG
Adult Protection Structured Decision Making Safety Plan to Address Current Danger Factors
DHS-6762D-ENG
Adult Protection SDM Strengths and needs Assessment/reassessment
DHS-6791B-ENG
MnCHOICES Community Support Plan with Coordinated Services and Supports Form
DHS-6791D-ENG
Coordinated Services and Supports Plan Signature Sheet
DHS-7168-ENG
DHS Performance Management System Performance Improvement Plans
DHS-7169-ENG
DHS Performance Management System Performance Improvement Plans for Measures with Small Denominators
DHS-7185-ENG
Case Manager's Recipient Information Form
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