Service Authorization Related Forms
| DMAS-7 | Medical Necessity Assessment and Personal Care (PDF) |
| DMAS-62 | Private Duty Nursing Service Authorization Form (PDF) |
| DMAS-62 FAQ | Private Duty Nursing Service Authorization Form FAQ (PDF) |
| DMAS-301 | Adult Day Health Care Interdisciplinary Plan of Care (PDF) |
| DMAS-351 | Prior Review And Authorization Request (PDF) |
| DMAS-352 | Certificate of Medical Necessity (PDF) |
| DMAS-362 | Inpatient Service Authorization Request Form (PDF) |
| DMAS-363 | Outpatient Service Authorization Request Form (PDF) |
| Assessment_Template_IACCT | IACCT Assessment Template (PDF) |
| DMAS-600T | Adult Day Health Care Interdisciplinary Plan of Care (PDF) |
| Out of State Questionnaire | Out of State Questionnaire - Behavioral health (PDF) |
| Revenue Code for Home Health | Revenue Codes for Home Health (PDF) |
| Specialized Care Long Stay Hospital Checklist | Specialized Care Long Stay Hospital Checklist (PDF) |