DHS-2828A-ENG Long-Term Services and Supports Notice of Action (Assessments and Reassessments)
DHS-2828B-ENG Long-Term Services and Supports Notice of Action (Service Plan)
DHS-2981-ENG Medical Assistance Parental Fee Form
DHS-3274-ENG Request for Approval To Incur Special Expenses
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-3531-ENG Application for Medical Assistance for Long-Term-Care Services (MA-LTC)
DHS-3550-ENG Minnesota Child Care Assistance Program Application
DHS-4258H-ENG Minnesota Corporate Child Foster Care Application (Foster Residence Setting)
DHS-4461-ENG Nursing Facility (NF) Communication Form
DHS-4839K-ENG Notice of Privacy Practices and Rights and Responsibilities for DHS-6696/6696B
DHS-5223D-ENG Combined Application - Child Care Addendum
DHS-5274-ENG Child Care Assistance Program Redetermination Form
DHS-5367-ENG Minnesota Child Care Assistance Programs - Parent Acknowledgment When Choosing a Legal Nonlicensed Provider
DHS-5485-ENG Child Care Assistance Program Authorization for Release of Information for In-home Child Care Providers
DHS-6340-ENG Other Health Insurance Reporting Form
DHS-6696D-ENG MNsure Appendix A - Health Coverage from Jobs
DHS-6762D-ENG MNsure Application for Health Coverage
DHS-6806-ENG Provider Assurance Statement for Telemedicine
DHS-7108A-ENG EIDBI Comprehensive Multi-Disciplinary Evaluation (CMDE) Medical Necessity Summary Information Signature Form (Addendum B)
DHS-7109A-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring Signature Form (Addendum A)
DHS-7109B-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring Provider Team Members List (Addendum B)
DHS-7109C-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring Week-in-the-Life Schedule (Addendum C)
DHS-7602-ENG Critical Access Dental Payment Program Encounter Data Request
DHS-7604-ENG Substance Use Disorder Provider Capacity Grant Application
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