Forms published to eDocs (April 2020)

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Forms published to eDocs

April 2020

eDocs

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-2981-ENG Medical Assistance Parental Fee Form

DHS-3725-ENG EFT Vendor Number Notification

DHS-3956-ENG Elderly Waiver Conversion Rate Request

DHS-3956A-ENG Elderly Waiver CDCS Conversion Rate Request

DHS-5504C-ENG Exception Request Checklist for Environmental Accessibility Adaptations that Exceed $40,000 (CAC, CADI, BI and DD waivers)

DHS-5887-ENG Additional Square Footage Checklist

DHS-6119-ENG TMD Treatment Authorization Form

DHS-6562-ENG Advisory Committee Application Form

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

DHS-6806A-ENG Telephonic Telemedicine Provider Assurance Statement

DHS-7118-ENG License universal application

DHS-7305-ENG Officer Involved Care Coordination

DHS-7311-ENG Child Care Center Temporary Change Form

DHS-7313-ENG COVID-19 Notification of Operation of Alternative Adult Day Services

DHS-7313A-ENG COVID-19 Modified Adult Day Service-Participant Record

DHS-7313B-ENG COVID-19 Attendance documentation record

DHS-7967-ENG Housing Transition and Housing Sustaining Applicant Assurance Statement

DHS-8007-ENG Parent Support Outreach Program (PSOP) Referral Form

DHS-8009-ENG Child Welfare opiate allocation – agency plan 

DHS-8010-ENG Child welfare opiate allocation – agency annual report

DHS-8018-ENG Housing Stabilization Services – Provider Enrollment Application

 

The following form(s) were made obsolete:

None


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