Alaska Department of Health and Social Services Forms

Use this Alaska-specific form for cases when you are not able to communicate your wishes or make decisions. These may include directions regarding the use of mechanical ventilation or feeding tubes, as well as certain surgeries and medications.

This Form is used for applying for services in Alaska.

This form is used for adults and children in Alaska who need long term care.

This form is used for applying for child care assistance in Alaska. It helps families access financial support for child care expenses.

This document is used for applying for child care assistance in Alaska with a licensed provider.

This document is for applying for child care assistance in Alaska.

This form is used for reporting confidential information about infectious diseases in Alaska. It helps in tracking and controlling the spread of diseases in the state.

This Form is used for reporting induced termination of pregnancy in Alaska.

This document is an agreement that authorizes and waives certain rights and responsibilities between a client and a business in Alaska.

This form is used for giving authorization to release information for a background check in Alaska.

This form is used for creating an IOU (I Owe You) document in Alaska without requiring proof.

This form is used for applying for a provisional child care license in Alaska.

This form is used for declaring and storing firearms and ammunition in Alaska. It provides guidelines for safe storage to ensure public safety.

This Form is used for reporting the presence of animals on a child care facility premises in Alaska.

This form is used for reporting attendance for the Child Care Grant program in Alaska. It is a manual form that must be filled out to track attendance at child care facilities.

This Form is used for providing information about family members residing in Alaska.

This document is used for pregnant women to apply for assistance in Alaska.

This document is used for applying for government programs and services for children in the state of Alaska.

This Form is used for applying for an infant's healthcare benefits in Alaska.

This document is used for applying for a program that provides support and resources for breastfeeding and postpartum women in Alaska.

This Form is used for requesting prior authorization for medications in the state of Alaska.

This form is used for Medicaid in Alaska to request prior authorization for certain opioid medications, including extended-release formulations. It is used for second-level review of opioid prescriptions to ensure appropriate use and minimize potential abuse.

This form is used for obtaining prior authorization for Suboxone/Buprenorphine through Alaska Medicaid.

This document is a Prior Authorization Form for Atypical Therapeutic Duplication, Exceeds Maximum Quantity Limits, or Child Less Than 5 Years Old in Alaska. It is used to request permission for medication that may be duplicated or exceeds quantity limits, or for children under 5 years old.

This form is used for requesting prior authorization for bid dosing of PPI medication in Alaska.

This form is used for obtaining prior authorization for the use of Botulinum Toxin in Alaska.

This form is used for requesting prior authorization for Medicaid coverage in Alaska specifically for the treatment of hemophilia or bleeding disorders. It includes an intake form and a prescribing/treatment plan.

This form is used for prior authorization of human growth hormone under the Alaska Medicaid program.

This Form is used for obtaining prior authorization for the medication Zyvox in Alaska.

This document certifies the standards of care for medical providers in Alaska. It ensures that healthcare professionals follow guidelines for patient care.

This form is used for requesting prior authorization for extended release opioids in the state of Alaska.

This form is used for making amendments to the service plan for personal care services in Alaska.

This form is used for requesting a waiver of in-person review of services in Alaska.

This document is a checklist for renewing your application for the Community First Choice Program in Alaska. It provides a list of required documents and steps to complete the renewal process.

This form is used for reporting changes in the status of residential habilitation services provided in a family home in Alaska.

This Form is used for notifying the Alaska government about the appointment or change of a program administrator.

This form is used for declaring and documenting the provision of day habilitation services in the state of Alaska.

This form is used for providers in Alaska to apply for certification for additional services.