Alaska Department of Health and Social Services Forms

This Form is used for gathering information about extended family members and family friends in Alaska

This document is used for expressing your healthcare wishes in Alaska. It allows you to designate a healthcare power of attorney and specify your healthcare preferences in case you are unable to make decisions for yourself.

This form is used for registering a new user account for the Alaska Background Check System.

This form is used for reporting cases of harm to protect vulnerable adults in Alaska. It aims to safeguard their well-being and ensure appropriate actions are taken to address any harm or abuse they may have experienced.

This document is used to request the transfer or extension of a variance in the state of Alaska. It is typically used to modify or renew a previously granted variance.

This form is used for requesting a redetermination of a background check in Alaska. It allows individuals to appeal the results of their background check and seek further review.

This document is used for transferring the variance in Alaska. It allows individuals or organizations to request the transfer of a variance to another location or property in the state.

This form is used for requesting an extension for filing your variance application in the state of Alaska.

This document is for referring members to the Alaska Medicaid Coordinated Care Initiative (AMCCI). It provides information on how to access coordinated care services through the program.

This type of document allows individuals in Alaska to refer themselves to the Medicaid Coordinated Care Initiative (AMCCI) for coordinated healthcare services.

This document is for applying for a waiver to waive the requirement of inspection for licensing and certification of health facilities in Alaska.

This document is used for applying for emergency licensure for hospitals and long-term care facilities in Alaska in case of emergencies or special circumstances.

This form is used for applying for a hospice agency license in Alaska.

This form is used for applying for Medicaid in Alaska for adults and children with long term care needs.

This Form is used for revoking authorization to release information in the state of Alaska.

This Form is used to request a change of recipient status in Alaska.

This Form is used for authorizing the release of information in Alaska.

This form is used to request an exception for monthly in-person visits in Alaska.

This form is used for requesting expedited consideration in the state of Alaska.

This document provides a checklist for the initial and renewal application process for the Alaska Initial and Renewal interim School Vouchers (ISW/IDD). It includes all the necessary requirements and steps for completing the application.

This form is used for authorizing the release of information in Alaska.

This document provides a checklist of the requirements for renewing an Ali/Apdd/Ccmc Care Coordinator certification in Alaska. It outlines the necessary documents and steps needed to complete the renewal process.

This type of document lists the initial application requirements and checklist for becoming a care coordinator in Alaska.

This form is used for requesting a cost estimate for door accessibility in Alaska.

This form is used for requesting a cost estimate for installing hand rails and grab bars in Alaska.

This form is used for requesting a cost estimate in Alaska.

This form is used for requesting a cost estimate for ramp access in Alaska.

This Form is used for requesting a cost estimate for a ramp cover in Alaska.

This form is used for requesting a cost estimate for a stair lift in Alaska.

This form is used for requesting a cost estimate for installing a roll-in shower in Alaska. It helps individuals or organizations plan and budget for the installation of an accessible shower in their home or building.

This form is used in Alaska to request a cost estimate other than the lowest for a specific project or service.

This Form is used for renewing the application for General Relief Assisted Living Care in Alaska.