Forms published to eDocs (February 2020)

Minnesota Department of Human Services sent this bulletin at 03/02/2020 07:51 AM CST

Forms published to eDocs

February 2020

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-2128-ENG Minnesota Health Care Programs Renewal for People Receiving Long-Term Care Services

DHS-2243-ENG MHCP Authorization for Release of Information About Assets

DHS-2402-ENG Change Report Form

DHS-3354C-ENG Managed Care Pre-enrollment Questionnaire

DHS-3628-ENG Notice of Denial of Child Support Good Cause Exemption

DHS-4209N-ENG Minnesota Family Investment Program (MFIP) education activity log

DHS-4533-ENG Get Your Child Support Payments Faster, Safer, Easier

DHS-4797B-ENG Behavioral Health Home (BHH) Services Rights, Responsibilities and Consent

DHS-6189C-ENG Adult Companion Services Providers Applicant Assurance Statement

DHS-6189H-ENG Elderly Waiver and Alternative Care Assurance Statement for Family Caregiver Applicants

DHS-7109A-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring Signature Form (Addendum A)

DHS-7118-ENG License universal application

DHS-7197-ENG Corrective Action Form - CCAP Case Review

DHS-7867-ENG Child Care Assistance Program Legal Nonlicensed Provider Monitoring Checklist

DHS-7979-ENG Authorization Request: D1110 Multiple Prophylaxis

DHS-8000-ENG Is a new license needed? and Change of Ownership form (CHOW)

DHS-2919A-ENG - Verification Request Form - A

DHS-2919B-ENG - Verification Request Form - B

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