Maine Department of Health and Human Services Forms
The Maine Department of Health and Human Services (DHHS) is responsible for providing a wide range of social services and programs to support the health and well-being of individuals and families in Maine. They work to ensure access to quality healthcare, promote public health and safety, and provide assistance for individuals and families in need. Some of the key areas that the DHHS focuses on include child welfare, public assistance, healthcare services, mental health and substance abuse treatment, and aging and disability services.
Documents:
120
This document is a template for a Business Associate Agreement in the state of Maine. It outlines the confidentiality and security requirements for a business associate working with a covered entity in the healthcare industry.
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This Form is used for reporting new hires in the state of Maine. Employers are required to submit this form to the Maine Department of Labor to comply with state reporting requirements.
This document is a scoring sheet for the PECFAS, which is a functional assessment scale used in Maine for evaluating the needs of preschool and early childhood children and their families in behavioral health treatment services.
This document provides instructions for applying for a new birth certificate in Maine following a legitimation. It guides you through the process of obtaining the updated document.
This form is used for creating an advance directive in the state of Maine. An advance directive is a legal document that allows individuals to specify their healthcare preferences and appoint someone to make medical decisions on their behalf if they become unable to do so.
This document is for reviewing the treatment plan of class members in the state of Maine.
This document is used for requesting the termination or interruption of services from an agency in the state of Maine.
This document is used for creating a service agreement in the state of Maine. It outlines the terms and conditions of the services to be provided and establishes the rights and responsibilities of both the service provider and the client.
This Form is used for applying for benefits in the state of Maine.
This form is used for entering into an agreement for personal support services in long-term care in the state of Maine.
This document is used for applying for Private Health Insurance Premium (PHIP) in the state of Maine.
This form is used to file a grievance with the Developmental Services department in the state of Maine.
This document is a report on repeat specimens submitted to the Newborn Bloodspot Screening Program in Maine.
This form is used for parents in Maine who wish to refuse the newborn bloodspot screening test for their baby.
This document provides directions and evidence for reviewing the treatment planning of class members in Maine. It guides the process of ensuring appropriate treatment plans for individuals in class action cases.
This form is used for reporting occupational diseases in the state of Maine. It helps track and monitor diseases that are associated with workplace exposure.
This form is used for applying for a retail tobacco sales license in the state of Maine. It is necessary for businesses that wish to sell tobacco products to complete this application.
This document is used for appointing an authorized representative in the state of Maine. It allows someone to act on behalf of another person or entity in legal or business matters.
This Form is used for applying for disability determination in Maine under the Mainecare program.
This Form is used for applying for Mainecare benefits in the state of Maine.
This document is an application for the Child Care Subsidy Program (CCSP) in the state of Maine. The CCSP provides financial assistance for qualifying families to help cover the costs of child care.
This document is a Family Contract used in Maine for the Aspire-TANF program. It outlines the responsibilities and requirements for families participating in the program.
This form is used for authorizing the release of personal information in the state of Maine. It allows individuals to give consent for their information to be shared with specific individuals or organizations.
This Form is used for reporting reportable conditions in the state of Maine. It is important to submit this form to help track and monitor public health issues in the state.
This form is used for applying for Covid-19 testing coverage in the state of Maine.
This document is a checklist for hospitals in Maine to complete their Mainecare cost report. It helps ensure that all necessary information is included in the report.
This document is a checklist used by MaineCare for the cost reporting of Intermediate Care Facilities for Individuals with Intellectual Disabilities and Related Conditions (ICF/MR). It provides guidance and requirements for reporting expenses and other financial information related to ICF/MR services provided in Maine.
This document is a checklist for completing a cost report for a Psychiatric Residential Treatment Facility in Maine under the Mainecare program.
