Alaska Department of Health and Social Services Forms

302
total templates

Documents

302

"Advance Directive for Health Care Form" - Alaska

Rate (4.6 / 5) 24 votes
Size: 115 KB
13 pages

Use this Alaska-specific form for cases when you are not able to communicate your wishes or make decisions. These may include directions regarding the use of mechanical ventilation or feeding tubes, as well as certain surgeries and medications.

Form VS-8 "Commemorative Certificate of Stillbirth Request Form" - Alaska

Rate (4.3 / 5) 21 votes
Size: 327 KB
2 pages

Form MED4 "Medicaid Application for Adults and Children With Long Term Care Needs" - Alaska

Rate (4.7 / 5) 18 votes
Size: 1 MB
10 pages

Form EM-5 "Request for Cost Estimate - Door Accessibility" - Alaska

Rate (4.6 / 5) 26 votes
Size: 182 KB
2 pages

Form EM-6 "Request for Cost Estimate - Elevated Toilet With Grab Bars" - Alaska

Rate (4.4 / 5) 27 votes
Size: 105 KB
2 pages

Form EM-4 "Request for Cost Estimate - Blank" - Alaska

Rate (4.8 / 5) 10 votes
Size: 76 KB
2 pages

Form EM-3 "Request for Cost Estimate - Bathroom Accessibility" - Alaska

Rate (4.6 / 5) 20 votes
Size: 212 KB
3 pages

Form EM-7 "Request for Cost Estimate - Hand Rails and Grab Bars" - Alaska

Rate (4.7 / 5) 22 votes
Size: 171 KB
2 pages

Form LTC-2 "Pre-admission Screening and Resident Review" - Alaska

Rate (4.6 / 5) 10 votes
Size: 1 MB
4 pages

Form CC1 "Request for Pass I Child Care" - Alaska

Rate (4.6 / 5) 28 votes
Size: 124 KB
1 page

Form UNI-18 "Nursing Oversight and Care Management Nursing Care Plan" - Alaska

Rate (4.5 / 5) 37 votes
Size: 471 KB
2 pages

Form CC35 "Request for Administrative Review" - Alaska

Rate (4.6 / 5) 52 votes
Size: 127 KB
1 page

Form UNI-17 "Nocm Care Provider Training Plan" - Alaska

Rate (4.6 / 5) 41 votes
Size: 1 MB
10 pages

Form PCS-08 "Personal Care Services Initial Application" - Alaska

Rate (4.7 / 5) 15 votes
Size: 1 MB
8 pages

Form MI-02 "Material Improvement Reporting for Ccmc Waivers" - Alaska

Rate (4.7 / 5) 15 votes
Size: 207 KB
4 pages

Form MI-04 "Material Improvement Reporting for Idd Participants Under the Age of Three" - Alaska

Rate (4.4 / 5) 22 votes
Size: 180 KB
2 pages

Form MI-03 "Material Improvement Reporting for Idd Participants Age Three or Over" - Alaska

Rate (4.3 / 5) 19 votes
Size: 264 KB
2 pages

Form TABI-02 "Tabi Verification of Diagnosis" - Alaska

Rate (4.3 / 5) 13 votes
Size: 100 KB
1 page

Form MI-01 "Material Improvement Reporting for Ali & Apdd Waivers" - Alaska

Rate (4.5 / 5) 10 votes
Size: 346 KB
6 pages

Form CERT-50 "Quality Improvement Report (Qir)" - Alaska

Rate (4.4 / 5) 10 votes
Size: 241 KB
7 pages

Form CERT-09 "Service Declaration: Residential Supported Living Services" - Alaska

Rate (4.6 / 5) 27 votes
Size: 451 KB
2 pages

Form UNI-12 "Request for Expedited Consideration" - Alaska

Rate (4.8 / 5) 17 votes
Size: 246 KB
1 page

Form CERT-13 "Service Declaration: Residential Habilitation Services Family Home Habilitation Site Information/Change of Status Report" - Alaska

Rate (4.8 / 5) 9 votes
Size: 233 KB
1 page

Form CERT-10 "Service Declaration: Day Habilitation Services" - Alaska

Rate (4.4 / 5) 17 votes
Size: 280 KB
2 pages

Form Tele-02 "Consent for Teleassessment" - Alaska

Rate (4.7 / 5) 14 votes
Size: 192 KB
2 pages

Form CC80 "Report of Family Non-payment" - Alaska

Rate (4.4 / 5) 11 votes
Size: 212 KB
3 pages

Form CC40 "In-home Child Care Application" - Alaska

Rate (4.6 / 5) 27 votes
Size: 256 KB
5 pages

Form CERT-42 "Report of Change: Provider Agency Information" - Alaska

Rate (4.8 / 5) 17 votes
Size: 233 KB
2 pages

Form EM-11 "Request for Cost Estimate: Stair Lift" - Alaska

Rate (4.5 / 5) 22 votes
Size: 108 KB
2 pages

Form EM-12 "Request for Cost Estimate - Vertical Lift" - Alaska

Rate (4.5 / 5) 19 votes
Size: 219 KB
2 pages

Form CERT-36 "Personal Care Services Provider Certification Application" - Alaska

Rate (4.7 / 5) 14 votes
Size: 294 KB
2 pages

Form PCA-10 "Personal Care Services Representative Designee or Community First Choice Personal Care Services Representative Designee" - Alaska

Rate (4.4 / 5) 5 votes
Size: 189 KB
1 page

Form CFC-04 (PCA-07) "Consumer Directed Personal Care Services (Cdpcs) and Community First Choice Consumer Directed Personal Care Services (Cfc/Cdpcs) Recipient and Cdpcs or Cfc/Cdpcs Provider Agency Contract" - Alaska

Rate (4.5 / 5) 26 votes
Size: 223 KB
3 pages

Form TABI-01 "Tabi Mini-Grant Application" - Alaska

Rate (4.8 / 5) 26 votes
Size: 328 KB
3 pages

Form PCA-03 "Personal Care Services Amendment to Service Plan" - Alaska

Rate (4.6 / 5) 9 votes
Size: 198 KB
2 pages

Form PCA-12 "Request for Waiver of in-Person Review of Services" - Alaska

Rate (4.6 / 5) 15 votes
Size: 169 KB
1 page

Form CFC-02 (PCS-15) "Application for Personal Care Services and Cfc-Personal Care Services When Traveling" - Alaska

Rate (4.3 / 5) 6 votes
Size: 248 KB
2 pages

Form CFC-05 (PCA-02) "Personal Care Services/Cfc Personal Care Services Request for Passive Range of Motion Personal Care Activity/Cfc Personal Care Activity" - Alaska

Rate (4.7 / 5) 11 votes
Size: 190 KB
1 page

Form PCS-13 "First Aid Training Completion Verification - Suggested Format" - Alaska

Rate (4.8 / 5) 19 votes
Size: 243 KB
1 page

Form PCS-12 "Request for Waiver of in-Person Review of Services" - Alaska

Rate (4.6 / 5) 22 votes
Size: 167 KB
1 page
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