DHS-2133-ENG Request for an MHCP Member's Claims Payment History

DHS-2776-ENG Computation of MFIP Overpayment Worksheet

DHS-2776C-ENG Computation of DWP Overpayment Worksheet

DHS-3779-ENG Conflict of Interest Disclosure Form

DHS-4163-ENG Client Responsibilities and Rights

DHS-4206A-ENG Monthly Outpatient Problem Gambling Service Report

DHS-4206C-ENG Quarterly Outpatient Problem Gambling Service Report

DHS-4296-ENG General Consent/Authorization for Release of Information

DHS-4794-ENG CCAP Change Report Form

DHS-6000-ENG Designation of Billing Person for Personal Care Assistance (PCA)

DHS-6428-ENG MHCP Synagis Authorization Form

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

DHS-6818-ENG COVID19 temporary staffing application

DHS-7190A-ENG DWRS cost report time-study worksheet

DHS-7220-ENG Emergency Client Support Request Form-Southern Region Southern Region

DHS-7221-ENG Emergency Client Support Request Form-Metro Region

DHS-7222-ENG Emergency Client Support Request Form-Northern Region

DHS-7223-ENG Emergency Client Support Request Form-Central Region

DHS-7356-ENG Child Care Assistance Program Accuracy Review

DHS-7645A-ENG EIDBI Benefit: Your rights and responsibilities

DHS-7652B-ENG Self-monitoring checklist for licensed HCBS providers: Admission and service initiation

DHS-7652C-ENG Self-monitoring checklist for licensed HCBS providers: Service delivery and evaluation

DHS-7652E-ENG Self-monitoring checklist for licensed HCBS providers: Emergency and incident response, reporting and review

DHS-7652H-ENG Self-monitoring checklist for licensed HCBS providers: Service recipient rights

DHS-7652K-ENG Self-monitoring checklist for licensed HCBS providers: Staff qualifications, orientation and training

DHS-7846-ENG Extended Inpatient Psychiatric Services Provider Application