Alaska Department of Health and Social Services Forms

This Form is used for obtaining consent for teleassessment services in Alaska.

This form is used for requesting a review of Medicaid clinical coverage in Alaska.

This document provides a projected budget worksheet for an assisted living home in Alaska. It helps in estimating and planning the financial aspects of running such a facility.

This document provides guidelines for creating a projected budget for an assisted living home in Alaska.

This document records details of an evacuation drill that took place in Alaska. It includes information about the date, time, location, and participants of the drill.

This document is a checklist used during employee orientation in the state of Alaska. It helps ensure that all necessary steps and training are completed for new employees.

This type of document is a medication set label specific to Alaska. It is used to provide important information about the medication included in the set.

This form is used for authorizing money management in Alaska. It allows individuals to grant someone else the authority to manage their financial affairs.

This document is a notice informing residents in Alaska that their home will be closed.

This notice informs customers in Alaska about an increase in charges for a certain service or product.

This document is a Notice of Involuntary Termination of Contract in the state of Alaska. It is used to inform all parties involved that a contract has been terminated against their will.

This document provides information about the Notice of Protection from Retaliation and Resident's Grievance policy and procedure in Alaska. It outlines the rules and procedures that protect individuals from retaliation and explains how residents can file a grievance.

This document outlines the specific rules and regulations that govern the conduct and behavior within a house in Alaska. It covers guidelines such as noise level, cleanliness, and shared responsibilities among residents.

This type of document provides a review of health-related services in Alaska. It offers information and feedback on various healthcare services available in the state.

This document is used for obtaining a physician's statement for assisted living in Alaska.

This form is used for individuals who are seeking association with a home in Alaska.

This document outlines the policy for refunding unused advance payment in case of termination of residential services contract or death of a resident in Alaska. It details the process and conditions for receiving a refund.

This document is a sample residential services contract specific to the state of Alaska. It outlines the terms and conditions for providing services related to residential property.

This document is used for conducting a restraint assessment in the state of Alaska. It helps evaluate the need for and appropriateness of physical restraints in certain situations.

This document records the notification of the proper disposal of medication in the state of Alaska. It helps ensure the safe and responsible disposal of medication to protect public health and the environment.

This type of document is used in Alaska for tracking and documenting the administration of medication. It helps ensure proper medication management and patient safety.

This document is used for the quarterly review of residents in Alaska. It helps track and assess their progress and performance.

This document outlines the plan for providing assisted living services in Alaska. It includes details on the services offered, facilities, and care provided to residents.

This document is used for recording important medical information for Alaska residents in case of emergencies.