 DHS-2128-ENG Minnesota Health Care Programs Renewal for People Receiving Medical Assistance for Long-Term Care Services (MA-LTC)
DHS-3418 - Minnesota Health Care Programs Renewal (HMN | RUS | SOM | SPA | VIE)
DHS-3539-ENG Ryan White Annual Certification
DHS-3539B-ENG Ryan White New Applicant Form
DHS-3539F-ENG Ryan White Information Change Form
DHS-3539Z-ENG Ryan White Program Application – Attachments
DHS-3550-ENG Minnesota Child Care Assistance Program Application (HMN | RUS | SOM | SPA | VIE)
DHS-3767D-ENG Determination of Cost Effectiveness
DHS-4049-ENG Billing Intermediaries, Clearinghouses and EDI Trading Partners Provider Enrollment Application
DHS-4138-ENG Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement
DHS-4461A-ENG Nursing Facility (NF) Liability Summary
DHS-4797 - Notification of Eligibility for Behavioral Health Home (BHH) Services (HMN | RUS | SOM | SPA | VIE)
DHS-4871-ENG MinnesotaCare Premium Statement
DHS-5032-ENG Moving Home Minnesota Intake Form
DHS-5274-ENG Minnesota Child Care Assistance Program Redetermination Form
DHS-6125-ENG SMRT Adult Disability Worksheet
DHS-7122 - Professional Statement of Need for Housing Stabilization Services and Minnesota Housing Support (AMH | HMN | ORM | SOM | SPA)
DHS-7645B-ENG EIDBI Benefit: Provider agency rights and responsibilities
DHS-7695-ENG Psychiatric Residential Treatment Facility (PRTF) Extended Leave Request
DHS-7846-ENG Extended Inpatient Psychiatric Services Provider Application
DHS-8355-ENG MCO In-Network Provider Agreement
DHS-8523-ENG Recommendation for Licensing Action
Form(s) made obsolete:
None
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