Kansas Department for Aging and Disability Services Forms

This Form is used for registering for the Uniform Program in Kansas.

This document is used for submitting monthly census summary data in the state of Kansas. It provides instructions on how to complete and submit Form AU-3902-A.

This document is used to make an open records request in the state of Kansas. It allows individuals to request access to public records maintained by government agencies in Kansas.

This document is for requesting a review of shared living arrangements in the state of Kansas. It is used to ensure the safety and quality of shared living spaces.

This document is a tool used to review and assess shared living homes in the state of Kansas. It helps ensure the quality and safety of these residential settings.

This document is a statement from a qualified mental health professional that authorizes admission to a psychiatric hospital in the state of Kansas. The statement is necessary for admission and highlights the individual's need for psychiatric care.

This Form is used for applying to the Community Support Medication Program (CSMP) in Kansas. This program provides medication support to eligible individuals in the community.

This form is used for authorizing individuals to sign the Community Support Medication Enrollment Form in Kansas.

This form is used for terminating participation in the Community Support Medication program in Kansas.

This document provides a checklist for inspecting the housing habitability standards in Kansas as part of Operation Community Integration (OCI). It helps ensure that housing conditions meet the required standards to promote community integration.

This Form is used for submitting a service request to Sud Services in Kansas.

This form is used for updating the National Provider Identifier (NPI) in the state of Kansas.

This document is a checklist used in Kansas for obtaining a limited scope license. It outlines the requirements and steps to be taken in order to obtain the license.

This document is used to request a waiver for an ID (identification) requirement in the state of Kansas.

This document is used for applying for an Idd Day and Residential Services License in the state of Kansas.

This form is used for nursing facilities in Kansas to enter into an agreement with a provider.

This document is for obtaining a full day or residential license in the state of Kansas. It is used to apply for a license that allows individuals or organizations to operate residential facilities or provide full-day care services.

This document is used for disclosing ownership and control interests in the state of Kansas. It provides information about individuals or entities that have ownership or control over a business or organization.

This document is a template for requesting aid for in-person visitation during the Covid-19 pandemic in Kansas.

This form is used for terminating PBS services through Kancare prior authorization in Kansas.

This form is used for obtaining prior authorization for PBS services under the Kancare program in Kansas.

This document is a template for collecting information about the visitation preferences of residents in Kansas. It is used to gather data on the activities, attractions, and amenities that residents prefer when visiting different places within the state.

This document is used for assessing the functional capacity of residents in Kansas. It helps to determine their ability to perform daily tasks and make appropriate care decisions.

This Form is used for screening symptoms of tuberculosis in Kansas residents.

This form is used for requesting the administrative transfer of a patient from Sia hospital to State Hospital in Kansas.

This document is used for screening youth at a community mental health center in Kansas. It helps identify mental health issues in young individuals and determine the appropriate care and support needed.

This type of document is a notice for participants who wish to disenroll from the Program of All-inclusive Care for the Elderly (PACE) in Kansas.

This form is an optional page for Grab and Go Meal Eligibility in Kansas. It is used for the Services Uniform Program Registration (UPR-001) page 2.

This Form is used for requesting authorization for level of care payment in Kansas.

This form is used for requesting a waiver of direct services in the state of Kansas.