| Title | Description | File Size | File Type |
| CMS 485 | EPSDT Home Health Certification and Plan of Care | 7 KB | .pdf |
| DMAS -363 Outpatient Fax form | OOS requirements updated 03/2013 | 57 KB | .docx |
| DMAS -7A | Agency Directed and Consumer Directed POC | 63 KB | .pdf |
| DMAS 351 | Procedures/Devices Service Authorization request Form | 194 KB | .doc |
| DMAS 362 A | Inpatient Psychiatric Continued Stay Review | 67 KB | .doc |
| DMAS 362-Inpatient Fax Form | OOS requirements updated 03/2013 | 43 KB | .docx |
| DMAS 363 A | Substance Abuse Service Authorization request form | 179 KB | .doc |
| DMAS 364 | TFC (Revised 10/2011) | 164 KB | .doc |
| DMAS 365 | Level AB (Revised 10/2011) | 190 KB | .doc |
| DMAS 365 RTC-C | OOS requirements updated 03/2013 | 55 KB | .docx |
| DMAS 366 | Intensive In-Home Service authorization request form | 114 KB | .doc |
| DMAS 367 | Community Mental health rehabilitative Service Authorization request form | 217 KB | .doc |
| DMAS 98- Community Based Care Request Form | Revised 1/10/2013- Community Based Care Request Form | 97 KB | .docx |
| DMAS 99 | Community Based Care Recipient Assessment Form | 34 KB | .docx |
| DMAS-352 | DME-Certificate of Medical Necessity | 82 KB | .docx |
| DMAS-62 | EPSDT Medical Needs Assessment | 78 KB | .pdf |
| DMAS-7 | EPSDT Personal Care-Functional Status Assessment | 22 KB | .pdf |
| DMAS-SPEC-100 | Long term Care facility and Home Based Services | 17 KB | .docx |
| VICAP | Independent Assessment (90889) | 138 KB | .doc |