Nevada Department of Health and Human Services Forms

This form is used for requesting prior authorization for ADHD treatment for recipients under the age of 18 in Nevada.

This Form is used for requesting prior authorization for the medication Ampyra in Nevada for individuals with Multiple Sclerosis.

This form is used for requesting prior authorization for the use of topical androgen agents in the state of Nevada.

This Form is used for requesting prior authorization for Makena (Hydroxyprogesterone Caproate Injection) in Nevada.

This Form is used for requesting prior authorization for psychotropic agents for children aged 0 to 5 in Nevada.

This Form is used for requesting prior authorization for psychotropic agents for children and adolescents between the ages of 6 to 18 in Nevada.

This Form is used for requesting prior authorization for the medication Cimzia (Certolizumab Pegol) in the state of Nevada.

This Form is used for requesting prior authorization for targeted immunomodulators in Nevada. It helps ensure that the use of these medications is appropriate and meets necessary criteria.

This form is used for submitting a prior authorization request for the medication Orencia (abatacept) in the state of Nevada.

This form is used for submitting a prior authorization request for the medication Kineret (Anakinra) in the state of Nevada.

This form is used for submitting a prior authorization request for the medication Stelara (Ustekinumab) in the state of Nevada.

This form is used for requesting prior authorization for the medication Remicade (Infliximab) in the state of Nevada.

This Form is used for requesting prior authorization for the medication Cesamet (Nabilone) in the state of Nevada.

This form is used for submitting a prior authorization request for Simponi (Golimumab) medication in Nevada.

This Form is used for requesting prior authorization for an opioid quantity limit in the state of Nevada.

This Form is used for submitting a prior authorization request for Marinol (Dronabinol) medication in Nevada.

This document is used for reviewing and evaluating physician care in Nevada's Medicaid hospice extended care program. It helps ensure that the care provided meets the necessary standards for Medicaid coverage.

This Form is used for the monthly emergency dialysis case certification in Nevada.

This Form is used for evaluating the functional plan of service in Nevada.

This document is for signing up for presumptive eligibility training in Nevada.

This Form is used for prior authorization of medical services in Nevada. It allows patients to request coverage for certain treatments or procedures.

This form is used for tracking nursing facility activities in the state of Nevada.

This form is used for requesting enrollment in the Behaviorally Complex Care Program in Nevada.

This type of document is a survey form used for collecting feedback from stakeholders of a PCS agency in Nevada.

This Form is used for submitting complaints related to dietitians or music therapists in Nevada.

This form is used for reporting capacity information to the Bureau of Behavioral Health Wellness and Prevention in Nevada. It helps track and monitor the availability of healthcare services related to behavioral health.

This form is used for applying for state prevention certification in the state of Nevada.

This form is used for the renewal approval of an EMS (Emergency Medical Services) course in Nevada.

This Form is used for signing in to the Emergency Medical Systems Program in Nevada.

This Form is used for the Emergency Medical Systems Program in Nevada to create a course roster for students.