Updated eDocs forms, instruction manuals and screening documents for long-term care assessments

Minnesota Department of Human Services logo

Aging and Adult Services and Disability Services division

eList Announcement

Date: Oct. 25, 2018
To: Lead agency staff
From: DHS Aging and Adult Services and Disability Services divisions
Purpose: To share information on two updated long-term care eDocs forms
Effective: Immediately
Contact: dhs.aasd.hcbs@state.mn.us

Updated eDocs forms, instruction manuals and screening documents for long-term care assessments

Form updates

DHS has updated the following documents:

HCBS Waiver, AC and ECS Case Management Transfer and Communication Form DHS-6037 (PDF)

Changes made:

  • Version date is 9/18
  • Current DHS logo added
  • “Client” changed to “person” throughout document
  • Person and guardian/conservator fields are separated for first and last name
  • Primary care clinic fields requires name and address
  • Last assessment date and type is separated into two fields
  • The Community Support Plan section is renamed Coordinated Services and Supports Plan (CSSP)
  • The formal and informal sections are reformatted
  • Small changes in verbiage added to instructions on last page
  • Date fields are checked for correct date format
  • Calendar popups are included
  • Phone numbers are formatted for ten digits
  • PMI and NPI numbers are checked for correct number of digits.

Service Agreement DHS-3070 (PDF)

Changes made:

  • Version date is 10/18
  • Current DHS logo added
  • ASA1 Section
    • Added calendars to date fields
    • Removed two fields: Provider ID number and referring provider ID number
    • Renumbered fields
  • ASA2 Section
    • Added PCA Choice field
    • Continued renumbering fields
  • Line item section
    • Continued renumbering fields.

Additional resources

For previous changes to these and other related forms, see the Sept 6, 2018, eList: Updated eDocs forms, instruction manuals and screening documents for long-term care assessments.

As always, all DHS forms can be found using the DHS eDocs portal


Previous eList announcement archives

AASD LEAD AGENCY | DSD LEAD AGENCY | DSD STAKEHOLDER