Alaska Department of Health and Social Services Forms

This document is used to request records from the Office of Children's Services in Alaska.

This Form is used for reporting material improvements made under the Ali & Apdd Waivers in Alaska.

This Form is used for granting limited power of attorney in Alaska. It allows an individual to authorize another person to act on their behalf for specific tasks or transactions.

This form is used for verifying the completion of first aid training in Alaska. It follows a suggested format for documenting and confirming the successful completion of the training.

This form is used for requesting authorization for a long-term care facility in Alaska.

This form is used for requesting immunization records in Alaska.

This type of document is used to record the medical history and physical examination findings of a patient in Alaska.

This Form is used to apply for a wait list in Alaska.

This form is used for requesting access to the NABCS provider system in Alaska.

This document is a checklist for a PCS agency in Alaska to request an inquiry regarding CFC providers in the Community First Choice program.

This document is a checklist used by a care coordinator to inquire about the services provided by a Cfc provider in the Community First Choice (Cfc) Program in Alaska.

This form is used for applying to the Alaska Commodity Supplemental Food Program (CSFP). CSFP provides eligible low-income individuals with nutritious food packages in Alaska.

This document is used for applying for a state license to operate a hospital in Alaska.

This document is used for applying for eligibility for the Senior Farmers' Market Nutrition Program (SFMNP) in Alaska. The program provides eligible seniors with coupons to purchase fresh fruits, vegetables, herbs, and honey from authorized farmers' markets.

This document is for designating a proxy representative for the Senior Farmers' Market Nutrition Program in Alaska. It is used to authorize someone to purchase and receive fresh, locally grown produce on behalf of a qualifying senior citizen.

This form is used for notifying the transfer of a business or entity in Alaska.

This Form is used for applying for modification to a state licensure in Alaska.

This document is for applying for a state license for an ambulatory surgical center in Alaska.

This document is for applying for a state license for a free-standing birth center in Alaska.

This type of document is used for applying for state licensure for long-term care facilities in Alaska. It is an application form that must be completed and submitted to the appropriate licensing agency.

This document is an application form for obtaining a state license for a Home Health Agency in the state of Alaska. It is required for those wishing to provide home health care services in the state.

This document is a checklist used by healthcare providers in Alaska to inquire about coverage and services for patients with Nfloc insurance (Ali, Apdd, Ccmc). It helps ensure that all necessary information is included in the request for coverage or services.

This document outlines the checklist for the initial application for the Community First Choice (CFC) Program in Alaska.

This document provides a checklist for renewing your application for the Community First Choice (CFC) Program in Alaska.

This Form is used for applying for an Ali (Assistive Living) or Apdd (Adult Public Developmental Disabilities) or Ccmc (Chronic and Complex Medical Conditions) designation in Alaska.

This form is used for applying for various benefits or services provided by the Alaska Department of Health and Social Services.