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-2237A-ENG Medical Service Questionnaire

DHS-4021-ENG Minnesota Health Care Programs - Notice of Returned Payment

DHS-4122C-ENG IEP Services Personal Care Assistant/Paraprofessional Activities Checklist

DHS-5086-ENG IEP Services Special Transportation Trip Log

DHS-6069B-ENG Child/Adolescent Diagnostic Verification Form

DHS-6696-ENG MNsure Application for Health Coverage and Help Paying Costs

DHS-6740-ENG MNsure Small Business Health Options Program (SHOP) Health Coverage Application for Employers

DHS-6740A-ENG MNsure Small Business Health Options Program (SHOP) Health Coverage Application for Employees

DHS-6806-ENG Provider Assurance Statement for Telemedicine

DHS-7093-ENG Application for Certification as a Behavioral Health Home (BHH)

DHS-7093A-ENG Behavioral Health Home (BHH) Request to Apply for Certification

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