 DHS-0035-ENG State Agency Appeals Summary
DHS-0312A-ENG Adoption Placement Decision Summary for a Child Under Guardianship of the Commissioner
DHS-2116-ENG (PDF) Notice to Apply for Other Maintenance Benefits
DHS-2978-ENG MHCP Medical Referral for MRRP Enrollee
DHS-3271-ENG Minnesota Health Care Programs Request for Information
DHS-3642-ENG Emergency Medical Assistance - Care Plan Certification Request
DHS-3891A-ENG (PDF) Request for Early Intensive Developmental and Behavioral Intervention (EIDBI) NETStudy 2.0 Agency ID Number
DHS-4016-ENG (PDF) MHCP Individual Provider Enrollment Application
DHS-4206A-ENG (PDF) Monthly Outpatient Problem Gambling Service Report
DHS-4207-ENG Gambling Service Agreement and Client Data Form
DHS-5181-ENG LTC: Communication of Long-term Supports and Services Eligibility Form
DHS-5207-ENG (PDF) County and Tribal Nation agency address and phone number list
DHS-5523-ENG (PDF) Child Care Assistance Billing Form
DHS-6189J-ENG (PDF) Home Delivered Meals Provider Assurance Statement
DHS-6451-ENG Special Needs BasicCare (SNBC) Choice Form
DHS-6762E-ENG (PDF) Minnesota Adult Protection SDM® Intake Assessment and Response Priority
DHS-6893A-ENG Community First Services and Supports (CFSS) Assessment
DHS-6893P-ENG CFSS Individual Service Delivery Plan
DHS-6893W-ENG Lead agency addendum to CFSS Individual Service Delivery Plan (DHS-6893P)
DHS-7120E-ENG (PDF) Early Intensive Developmental and Behavioral Intervention (EIDBI) Level II Provider Assurance Statement
DHS-7120F-ENG (PDF) Early Intensive Developmental and Behavioral Intervention (EIDBI) Level III Provider Assurance Statement
DHS-7309-ENG (PDF) Patient Referral Arrangement Agreement
DHS-7890-ENG Partial Hospitalization Program (PHP) Provider Application
DHS-7995-ENG Individual Child Care Program Plan - For Licensed Child Care Centers
DHS-8157-ENG Elderly Waiver Customized Living Services Disproportionate Share Facility Application
DHS-8748-ENG (PDF) Recuperative Care Surety Bond
DHS-3244A-ENG - PCA Assessment and Service Plan Instructions and Guidelines
DHS-3244-ENG - PCA Assessment and Service Plan
DHS-3244P-ENG - Referral for Reassessment for PCA services
DHS-3437A-ENG - MFPP - Giving Permission for Someone to Act on My Behalf
DHS-3458-ENG - Minnesota Senior Health Options brochure
DHS-3834-ENG - SNP NF Service Authorization Template
DHS-5190 - Minnesota Child Care Assistance Programs Licensed Center Provider Registration and Acknowledgment (HMN, SOM, SPA)
DHS-5191 - Minnesota Child Care Assistance Programs License Exempt Provider Registration and Acknowledgment (SOM, SPA)
DHS-5242-ENG - Child Care Assistance Notice of Decision
DHS-6762C-ENG - Minnesota Adult Protection Structured Decision Making Safety Plan to Address Current Danger Factors
DHS-7195 - Licensed Family Child Care Provider Registration and Acknowledgment (HMN, SOM, SPA)
DHS-7412A-ENG - Blue Plus service authorization process for MHCP programs with and without waiver
DHS-7412B-ENG - HealthPartners service authorization process for MHCP programs with and without waiver
DHS-7412C-ENG - Hennepin Health service authorization process for MHCP programs with and without waiver
DHS-7412D-ENG - IMCare service authorization process for MHCP programs with and without waiver
DHS-7412E-ENG - Medica service authorization process for MHCP programs with and without waiver
DHS-7412-ENG - SNP Managed Care Service Authorization Request Processes
DHS-7412F-ENG - PrimeWest Health service authorization process for MHCP programs with and without waiver
DHS-7412G-ENG - SCHA service authorization process for MHCP programs with and without waiver
DHS-7412H-ENG - UCare service authorization process for MHCP programs with and without waiver
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