South Dakota Department of Social Services Forms

This form is used for requesting prior authorization for durable medical equipment in South Dakota.

This form is used for requesting prior authorization for medical nutrition services in South Dakota.

This form is used for requesting prior authorization for long term acute care or out-of-state rehab services in South Dakota.

This form is used for verifying child care expenses in South Dakota.

This form is used for verifying completion of orientation training in South Dakota.

This document provides a report on the placement status of a child under the Interstate Compact on the Placement of Children in South Dakota.

This form is used for reimbursement of non-emergency medical travel expenses in South Dakota. It is specifically for the Non-Emergency Medical Travel (NEMT) program.

This form is used for authorizing payment for non-emergency medical travel in South Dakota. It is available in both English and Spanish.

This Form is used for authorizing the use or disclosure of protected health information for Medicaid non-emergency medical travel in South Dakota.

This form is used for referring individuals to the Medicaid Health Home program in South Dakota.

This Form is used for individuals in South Dakota who would like to request screening for substantiated reports of child abuse or neglect.

This form is used for agencies in South Dakota to request screening for substantiated reports of child abuse or neglect.

This form is used for applying to the Chronic Renal Disease Program in South Dakota. It helps individuals with chronic kidney disease access necessary treatment and support.

This form is used for selecting or changing a Medicaid Health Home provider in South Dakota.

This Form is used for referring individuals to the Medicaid Certified Community Mental Health Center (CMHC) Health Home program in South Dakota. It helps individuals access integrated physical and mental health care services.

This form is used for declining participation in the Medicaid Health Home program in South Dakota.

This document is used for tiering health homes in South Dakota.

This Form is used for applying for disability accommodation under the Americans with Disabilities Act (ADA) in South Dakota.

This Form is used for applying as a helper in South Dakota.

This form is used for creating a formal agreement between a parent and a child care provider in South Dakota. It outlines the terms and conditions of the child care arrangement, including fees, schedules, and responsibilities.

This form is used to provide procedures for identifying child abuse and neglect in South Dakota. It also includes an acknowledgement of responsibility to report such cases.

This form is used for reporting Medicaid credit balances in South Dakota.