Arizona Health Care Cost Containment System Forms

This form is used for applying for Ahcccs Children's Rehabilitative Services Designation in Arizona.

This Form is used for requesting designation for rehabilitation services for minors under AHCCCS in Arizona.

This form is used for reporting the conditions of a person's release in Arizona. It provides information about the terms and restrictions that must be followed by the individual.

This Form is used for updating information on youth in tribal foster care in Arizona.

This Form is used for applying for approval of a Direct Care Worker (DCW) training and testing program in Arizona.

This form is used for the medical director or designee of an inpatient psychiatric acute care hospital in Arizona to provide a statement.

This Form is used for the Outpatient Assessment Report in the state of Arizona. It is used to collect information about a patient's health and treatment progress during their outpatient visit.

This form is used for conducting a 60-day review of residential or psychiatric treatment services in Arizona.

This document provides transaction information for the Standard Companion Guide in Arizona. It outlines the required information and processes for conducting transactions in the state.

This Form is used for requesting an AHCCCS member ID for the American Indian Health Program in Arizona.

This form is used for requesting application for Arizona Long Term Care System (ALTCS) in Arizona.

This form is used by schools in Arizona to refer students for counseling, special education, or other supportive services. Perfect for educators and school administrators looking to provide additional assistance for students in need.

This form is used for requesting changes to the American Indian Health Program in Arizona.

This document attests to the completion of staff training for employment in Arizona.