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- United States Legal Forms
- Kansas Legal Forms
- Kansas Department for Aging and Disability Services
Documents
33
![Form I/DD-1 "I/DD Medicaid Waiver Individual Choice" - Kansas](https://data.templateroller.com/pdf_docs_html/2025/20259/2025969/form-i-dd-1-i-dd-medicaid-waiver-individual-choice-kansas.png "Form I/DD-1 "I/DD Medicaid Waiver Individual Choice" - Kansas")
![Instructions for Form KDADS-PRTF-01 "Psychiatric Residential Treatment Facility Financial and Statistical Report (Cost Report)" - Kansas](https://data.templateroller.com/pdf_docs_html/2009/20099/2009933/instructions-for-form-kdads-prtf-01-psychiatric-residential-treatment-facility-financial-and-statistical-report-cost-report-kansas.png "Instructions for Form KDADS-PRTF-01 "Psychiatric Residential Treatment Facility Financial and Statistical Report (Cost Report)" - Kansas")
![KDADS Form UPR-001 "Uniform Program Registration" - Kansas](https://data.templateroller.com/pdf_docs_html/2064/20645/2064518/kdads-form-upr-001-uniform-program-registration-kansas.png "KDADS Form UPR-001 "Uniform Program Registration" - Kansas")
![KDADS Form SI-002 "Standard Intake & Information Form" - Kansas](https://data.templateroller.com/pdf_docs_html/1805/18059/1805909/kdads-form-si-002-standard-intake-information-form-kansas.png "KDADS Form SI-002 "Standard Intake & Information Form" - Kansas")
![KDADS Form SS-009 "Customer Service Worksheet" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17995/1799500/kdads-form-ss-009-customer-service-worksheet-kansas.png "KDADS Form SS-009 "Customer Service Worksheet" - Kansas")
![KDADS Form FAI-001 "Functional Assessment Instrument" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799452/kdads-form-fai-001-functional-assessment-instrument-kansas.png "KDADS Form FAI-001 "Functional Assessment Instrument" - Kansas")
![KDADS Form SS-012 "Sca/Oaa Customer Rights and Responsibilities" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799494/kdads-form-ss-012-sca-oaa-customer-rights-and-responsibilities-kansas.png "KDADS Form SS-012 "Sca/Oaa Customer Rights and Responsibilities" - Kansas")
![KDADS Form SS-025 "Iii-E Caregiver Assessment Plan" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799487/kdads-form-ss-025-iii-e-caregiver-assessment-plan-kansas.png "KDADS Form SS-025 "Iii-E Caregiver Assessment Plan" - Kansas")
![KDADS Form SS-003 "Abbreviated Uniform Assessment Instrument" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799497/kdads-form-ss-003-abbreviated-uniform-assessment-instrument-kansas.png "KDADS Form SS-003 "Abbreviated Uniform Assessment Instrument" - Kansas")
![KDADS Form SS-028 "Legal Services Reporting Form" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17995/1799502/kdads-form-ss-028-legal-services-reporting-form-kansas.png "KDADS Form SS-028 "Legal Services Reporting Form" - Kansas")
![KDADS Form SS-005 "Uniform Assessment Instrument" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799493/kdads-form-ss-005-uniform-assessment-instrument-kansas.png "KDADS Form SS-005 "Uniform Assessment Instrument" - Kansas")
![KDADS Form SS-046 "Corrective Action Plan" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799490/kdads-form-ss-046-corrective-action-plan-kansas.png "KDADS Form SS-046 "Corrective Action Plan" - Kansas")
![KDADS Form SS-043 "Customer Code of Conduct" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799496/kdads-form-ss-043-customer-code-conduct-kansas.png "KDADS Form SS-043 "Customer Code of Conduct" - Kansas")
![KDADS Form AP-2204 "Limited Scope License" - Kansas](https://data.templateroller.com/pdf_docs_html/1805/18059/1805912/kdads-form-ap-2204-limited-scope-license-kansas.png "KDADS Form AP-2204 "Limited Scope License" - Kansas")
![Form AP-2204 "License Application" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799481/form-ap-2204-license-application-kansas.png "Form AP-2204 "License Application" - Kansas")
![Instructions for Form MS-2004 "Nursing Facility Financial and Statistical Report" - Kansas](https://data.templateroller.com/pdf_docs_html/2025/20259/2025966/instructions-for-form-ms-2004-nursing-facility-financial-and-statistical-report-kansas.png "Instructions for Form MS-2004 "Nursing Facility Financial and Statistical Report" - Kansas")
!["Idd Notification Form With Provisional Plan of Care" - Kansas](https://data.templateroller.com/pdf_docs_html/2025/20259/2025968/idd-notification-form-with-provisional-plan-of-care-kansas.png ""Idd Notification Form With Provisional Plan of Care" - Kansas")
!["Resident Review Check List" - Kansas](https://data.templateroller.com/pdf_docs_html/2009/20099/2009934/resident-review-check-list-kansas.png ""Resident Review Check List" - Kansas")
!["Authorization for Release of Protected Health Information" - Kansas](https://data.templateroller.com/pdf_docs_html/1805/18058/1805890/authorization-release-protected-health-information-kansas.png ""Authorization for Release of Protected Health Information" - Kansas")
!["Resident Review Required Documentation" - Kansas](https://data.templateroller.com/pdf_docs_html/1816/18160/1816008/resident-review-required-documentation-kansas.png ""Resident Review Required Documentation" - Kansas")
!["Consumer Evaluation of Needs - Hcbs - Physical Disability" - Kansas](https://data.templateroller.com/pdf_docs_html/1805/18058/1805894/consumer-evaluation-needs-hcbs-physical-disability-kansas.png ""Consumer Evaluation of Needs - Hcbs - Physical Disability" - Kansas")
!["Full/Tcm License Checklist" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799472/full-tcm-license-checklist-kansas.png ""Full/Tcm License Checklist" - Kansas")
!["Case Management Entity (Cme) Referral and Response Form - Kdads Scc Quality Review" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799499/case-management-entity-cme-referral-and-response-form-kdads-scc-quality-review-kansas.png ""Case Management Entity (Cme) Referral and Response Form - Kdads Scc Quality Review" - Kansas")
!["Kdads Care Special Admission Fax Memo" - Kansas](https://data.templateroller.com/pdf_docs_html/1810/18106/1810676/kdads-care-special-admission-fax-memo-kansas.png ""Kdads Care Special Admission Fax Memo" - Kansas")
!["Application for Reinstatement - Kansas Adult Care Home Administrator License" - Kansas](https://data.templateroller.com/pdf_docs_html/324/3245/324550/application-reinstatement-kansas-adult-care-home-administrator-license-kansas.png ""Application for Reinstatement - Kansas Adult Care Home Administrator License" - Kansas")
!["Worksheet for Private Pay Rate (Private Pay Census Only, No Medicaid)" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799467/worksheet-private-pay-rate-private-pay-census-only-no-medicaid-kansas.png ""Worksheet for Private Pay Rate (Private Pay Census Only, No Medicaid)" - Kansas")
!["Worksheet for Private Pay Rate" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799473/worksheet-private-pay-rate-kansas.png ""Worksheet for Private Pay Rate" - Kansas")
!["Worksheet for Level of Care (Private Pay Census Only, No Medicaid or Medicare)" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799470/worksheet-level-care-private-pay-census-only-no-medicaid-or-medicare-kansas.png ""Worksheet for Level of Care (Private Pay Census Only, No Medicaid or Medicare)" - Kansas")
!["Senior Care Act Physician/Rn Statement for Customer Directed Attendant Care (Health Maintenance Activities)" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17995/1799501/senior-care-act-physician-rn-statement-customer-directed-attendant-care-health-maintenance-activities-kansas.png ""Senior Care Act Physician/Rn Statement for Customer Directed Attendant Care (Health Maintenance Activities)" - Kansas")
!["Justification for Extraordinary Funding" - Kansas](https://data.templateroller.com/pdf_docs_html/1805/18059/1805906/justification-extraordinary-funding-kansas.png ""Justification for Extraordinary Funding" - Kansas")
!["Request for Extraordinary Funding" - Kansas](https://data.templateroller.com/pdf_docs_html/1805/18059/1805913/request-extraordinary-funding-kansas.png ""Request for Extraordinary Funding" - Kansas")
!["Basis Assessment Instrument" - Kansas](https://data.templateroller.com/pdf_docs_html/1799/17994/1799463/basis-assessment-instrument-kansas.png ""Basis Assessment Instrument" - Kansas")
!["Determine Your Nutritional Health" - Kansas](https://data.templateroller.com/pdf_docs_html/2064/20645/2064519/determine-your-nutritional-health-kansas.png ""Determine Your Nutritional Health" - Kansas")
Kansas Department for Aging and Disability Services Forms
33
total templates