Service Authorization Related Forms
| DMAS-600T | Adult Day Health Care Interdisciplinary Plan of Care (PDF) |
| DMAS-352 | Certificate of Medical Necessity (PDF) |
| DMAS-7 | Medical Necessity Assessment and Personal Care (PDF) |
| DMAS-301 | Adult Day Health Care Interdisciplinary Plan of Care (PDF) |
| PDF File | Revenue Codes for Home Health (PDF) |
| PDF File | Revenue Codes/Corresponding CPT Codes for Outpatient Rehabilitation Procedures (PDF) |
| DMAS-362 | Inpatient Service Authorization Request Form (PDF) |
| DMAS-363 | Outpatient Service Authorization Request Form (PDF) |
| DMAS-62 | Private Duty Nursing Service Authorization Form (PDF) |
| Assessment_Template_IACCT | IACCT Assessment Template |
| Out of State Questionnaire | Out of State Questionnaire |