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DHS-3427-ENG LTC Screening Document - AC, BI, CAC, CADI, ECS, EW, MHM, MSC+, MSHO, SNBC
DHS-3428-ENG Minnesota Long-Term Care Consultation Services Assessment Form
DHS-3428A-ENG Minnesota Long-Term Care Consultation Services Assessment Form: SW Section
DHS-3525-ENG Minnesota Health Care Programs Application and Renewal Form Medical Assistance for Women with Breast or Cervical Cancer (MA-BC)
DHS-3767-ENG Required Information from an Employer for an Employee’s MA Cost-Effective Health Insurance Determination
DHS-3767A-ENG Required Information from an Insurer for an MA Member's Cost-Effective Health Insurance Determination
DHS-3767B-ENG Prorating Premium Amounts to Decide Whether Health Insurance Is Cost Effective
DHS-3767C-ENG Cost-Effective-Insurance Calculation
DHS-3767D-ENG Cost-Effective Health Insurance Referral to a Medical Assistance Member
DHS-3767E-ENG Your Health Insurance Is Cost Effective
DHS-3767F-ENG Your Health Insurance Is Not Cost Effective
DHS-3767G-ENG Medical Assistance Will Stop Paying Your Health Insurance Premium
DHS-3767H-ENG Application for a Cost-Effective Hardship Waiver
DHS-3767I-ENG Hardship Determination for Cost-Effective Health Insurance
DHS-3767J-ENG Agency Appeals Summary for Cost-Effective Health Insurance (CEHI)
DHS-3813-ENG User Agreement for MEC² PRO Electronic Billing
DHS-3873-ENG Supported Employment Service Providers - Moving Home Minnesota - Applicant Assurance Statement
DHS-3879-ENG Moving Home Minnesota (MHM) - Transition Planning, Transition Coordination and Demonstration Case Management Providers - Applicant Assurance Statement
DHS-3912-ENG Community-Based Services (CBS) Program Referral Form
DHS-4159-ENG CTSS Authorization Form
DHS-4583-ENG Child Support Division - Request for Exception to Direct Deposit
DHS-5339-ENG Education and Training Voucher Program (ETV) Application and Renewal
DHS-5339A-ENG Education and Training Voucher Program (ETV) Verification of Eligibility
DHS-5924-ENG Group Residential Housing (GRH) Supplemental Services – Provider Enrollment Application
DHS-6552-ENG DeafBlind Consumer Directed Services - Service and Budget Agreement
DHS-6633A-ENG CDCS Community Support Plan Addendum with 2017 Provider Rate Increase
DHS-6789B-ENG Participant Consent for use of Monitoring Technology
DHS-6789C-ENG Affected Participant Consent for use of Monitoring Technology
DHS-7181-ENG Mental Health Adult Rehabilitative Mental Health Services (ARMHS) Provider Application
DHS-7181C-ENG Mental Health Adult Rehabilitative Mental Health Services (ARMHS) Branch Office Location Application
DHS-7414A-ENG Child Care Emergency Plan
DHS-7418-ENG Host County Notification of Residential Placement Form
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