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DHS-0312-ENG Adoption Placement Agreement for a Child Under Guardianship of the Commissioner
DHS-2327-ENG Medical Necessity Statement
DHS-2630-ENG Alternative Care Program Eligibility Worksheet
DHS-2630A-ENG Alternative Care Program Eligibility Worksheet Type A
DHS-3754-ENG Service Agreement and Screening Document (SASD) Support Team Portal
DHS-4016-ENG MHCP Individual Provider Enrollment Application
DHS-4138-ENG Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement
DHS-5143-ENG Required Annuity Information
DHS-5239F-ENG Minnesota Family Planning Program Application and Renewal Form – Signature Page
DHS-6322-ENG Initial Dialectical Behavior Therapy (DBT) Intensive Outpatient Program (IOP) Authorization
DHS-6322A-ENG Additional Dialectical Behavior Therapy (DBT) Intensive Outpatient Program (IOP) Authorization
DHS-6638-ENG Home and Community-Based Services (HCBS) Programs Service Request
DHS-6683-ENG Essential Community Supports Program (ECS) Financial Eligibility Worksheet
DHS-6683A-ENG Essential Community Supports Program (ECS) Eligibility Worksheet for a Married Individual when only one spouse is requesting services
DHS-7118-ENG Universal Licensing Application
DHS-7340-ENG Officer-Involved Community-Based Care Coordination Assurance Statement
DHS-7618-ENG Home and Community-Based Services (HCBS) Settings Provider Assurance Statement
DHS-8059-ENG Waiver Services Remote Support Provider Assurance Statement
DHS-8097-ENG Qualified Residential Treatment Program (QRTP) Placement Assessment and Recommendation Form
DHS-8368-ENG Necessity of Care Recommendation/Referral Checklist
DHS-8382-ENG Qualified Individual Contract Application
Form(s) made obsolete:
DHS-6218-ENG Housing Access Coordination Exception Request for people with criminal, subpar credit or eviction history
DHS-6218A-ENG Housing access coordination (HAC) service authorization and billing
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