Nevada Department of Health and Human Services Forms

This Form is used for withdrawing participation in a program or event in Nevada.

This Form is used for reporting third party incidents in Nevada.

This document is used for requesting alternative certification in the state of Nevada.

This form is used for requesting a referral in Nevada for the Atap program.

This document is used for applying for Senior Rx or Disability Rx programs in Nevada.

This document is used for requesting a child abuse and neglect screening in the state of Nevada. It is aimed at ensuring the safety and well-being of children by assessing possible cases of abuse or neglect.

This form is used for individuals in Nevada to request a screening for child abuse or neglect. It allows residents to ensure the safety and well-being of children by reporting potential instances of abuse or neglect.

This document is used for employers in Nevada to request information from the Child Abuse & Neglect Central Registry regarding potential employees and their history in child abuse and neglect cases.

This document is used for authorizing correspondence in the state of Nevada.

This document is used for obtaining parental permission for a child's participation in an event or activity in the state of Nevada.

This document is for obtaining consent for individuals to participate in religious activities in the state of Nevada.

This document is a court notification specifically for children in the state of Nevada. It provides important information regarding relevant legal matters that may impact the child's interests or welfare.

This Form is used for reporting runaway individuals in Nevada.

This form is used for determining tribal eligibility and providing notice of court proceedings related to the Indian Child Welfare Act (ICWA) in the state of Nevada.

This document confirms the resource placement for individuals in Nevada. It serves as a statement of confirmation regarding their placement in a job or educational program.

This document is a financial and medical plan specific to the state of Nevada. It outlines the coverage and benefits available to residents in terms of both financial assistance and medical services.

This document is a general checklist for the International Child Protection Certificate (ICPC) requirements in the state of Nevada. It outlines the necessary steps and information needed for obtaining the ICPC.

This document is for the selection of a Medicaid Electronic Visit Verification (EVV) Provider System in the state of Nevada. EVV is a system that electronically verifies the occurrence of authorized personal care services to Medicaid beneficiaries.

This form is used for submitting an appeal regarding the pricing of Mac products in Nevada.

This Form is used for requesting prior authorization for the medication Elidel (Pimecrolimus) in Nevada.

This form is used for requesting prior authorization for high dollar claims in Nevada. It is designed to ensure that the claim meets specific criteria before it is approved for payment.

This document is a Prior Authorization Request Form for the medication Protopic (Tacrolimus) in the state of Nevada. It is used to seek approval from the healthcare provider or insurance company for coverage of this medication.

This form is used for requesting prior authorization for Eucrisa medication in Nevada.

This Form is used for requesting prior authorization for the medication Daliresp in the state of Nevada.

This form is used for requesting prior authorization for Lidoderm 5% Patches in Nevada.

This form is used for submitting a prior authorization request for Zolgensma medication in the state of Nevada. The form is used to seek approval for coverage of this specific medication.

This Form is used for requesting prior authorization for Continuous Glucose Monitors (CGMs) in the state of Nevada.

This form is used for requesting prior authorization for insulin pump coverage in Nevada.

This Form is used for requesting prior authorization for hematopoietic/hematinic agents in Nevada.

This document provides instructions for applying for a J-1 Physician Visa Waiver in the state of Nevada. It includes detailed steps and requirements for the application process.

This document is a confidentiality agreement for users of the Nevada Webiz system who only have view-only access. It outlines the responsibilities and obligations of the user to keep the information they access confidential.

This Form is used for enrolling in the Nvhan Only program in Nevada.