Alaska Department of Health and Social Services Forms

This Form is used for applying for general relief benefits for assisted living home care in Alaska.

This form is used to request a cost estimate for installing an elevated toilet with grab bars in Alaska.

This Form is used for requesting a cost estimate for a vertical lift in Alaska.

This Form is used for the contract between the recipient and provider agency for Consumer Directed Personal Care Services (CDPCS) and Community First Choice Consumer Directed Personal Care Services (CFC/CDPCS) in Alaska.

This Form is used for requesting passive range of motion personal care services in Alaska.

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

This form is used for verifying the completion of first aid training in Alaska. It provides a suggested format for documenting the training completion.

This form is used for applying for Personal Care Services (PCS) and CFC-Personal Care Services When Traveling in Alaska.

This form is used for creating a shared agency service agreement in Alaska. It outlines the terms and conditions for a shared agency arrangement between two or more parties.

This Form is used for applying for a certification as a waiver services provider in Alaska.

This document is for individuals applying for or renewing their certification as a Care Coordinator in Alaska.

This form is used for making amendments to the service plan for the Community First Choice program in Alaska. It allows individuals to make changes to their service plan to better meet their needs.

This form is used for declaring care coordination services in Alaska.

This form is used for declaring adult day services in Alaska.

This form is used for reporting changes in the residential habilitation services provided in group-home habilitation sites in Alaska.

This form is used for declaring respite care services provided in Alaska.

This form is used for declaring transportation services in Alaska.

This Form CERT-18 Service Declaration is used for declaring the meal services provided in the state of Alaska.

This form is used for declaring and documenting environmental modification services in Alaska.

This form is used for provider certification assurance on policies in Alaska. It ensures that healthcare providers are following the necessary policies and regulations set by the state.

This Form is used for declaring nursing oversight and care management services in Alaska.

This Form is used for reporting changes to the provider agency information in Alaska. It helps agencies in Alaska to update their information to ensure accurate reporting.

This form is used for care coordinators in Alaska to disclose their business and familial relationships. It helps ensure transparency and integrity in the healthcare system.

This form is used for declaring intensive active treatment services in Alaska.

This is a form used in Alaska for declaring supported employment services.

This Form is used for declaring residential supported living services in Alaska.

This form is used for reporting material improvements and waivers related to the CCMC in Alaska.

This form is used for reporting changes in care coordinator information in the state of Alaska.

This form is used for requesting a waiver of First Aid and CPR training for first-time personal care assistants in Alaska.

This Form is used for declaring chore services in Alaska.

This Form is used for applying for a conflict of interest exception in Alaska.