Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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BH-01 | Federal Poverty Level Guidelines | n/a | n/a | n/a |  |  |
BH-02 | Financial Eligibility Form | n/a | n/a | n/a |  |  |
BH-03 | 102a Hardship Considerations | n/a | n/a | n/a |  |  |
BH-04 | 102b Hardship Considerations | n/a | n/a | n/a |  |  |
BH-05 | Hardship Considerations Refusal | n/a | n/a | n/a |  |  |
BH-06 | 3rd Party Release of Information (ROI) | n/a |  | n/a |  |  |
BH-07 | Mental Health - Accreditation Application | n/a |  | n/a |  |  |
BH-08 | Mental Health - IMPACT Application | n/a |  | n/a |  |  |
BH-09 | Indigent Medication Application | n/a | n/a | n/a |  |  |
BH-09a | Indigent Medication Update-Extension Application | n/a | n/a | n/a |  |  |
BH-11 | Behavioral Health Treatment Outcomes Program Manual | n/a | n/a | n/a |  |  |
BH-11a | Adult SUD Initial Outcome Tool | n/a | n/a | n/a |  |  |
BH-11b | Adult SUD Update Outcome Tool | n/a | n/a | n/a |  |  |
BH-11c | Adult SUD Discharge Outcome Tool | n/a | n/a | n/a |  |  |
BH-11d | Adult MH Initial Outcome Tool | n/a | n/a | n/a |  |  |
BH-11e | Adult MH Update Outcome Tool | n/a | n/a | n/a |  |  |
BH-11f | Adult MH Discharge Outcome Tool | n/a | n/a | n/a |  |  |
BH-12a | Youth SUD Initial Outcome Tool | n/a | n/a | n/a |  |  |
BH-12b | Youth SUD Update Outcome Tool | n/a | n/a | n/a |  |  |
BH-12c | Youth SUD Discharge Outcome Tool | n/a | n/a | n/a |  |  |
BH-12d | Youth MH Initial Outcome Tool | n/a | n/a | n/a |  |  |
BH-12e | Youth MH Update Outcome Tool | n/a | n/a | n/a |  |  |
BH-12f | Youth MH Discharge Outcome Tool | n/a | n/a | n/a |  |  |
BH-13a | Family SUD Initial Outcome Tool | n/a | n/a | n/a |  |  |
BH-13b | Family SUD Update Outcome Tool | n/a | n/a | n/a |  |  |
BH-13c | Family SUD Discharge Outcome Tool | n/a | n/a | n/a |  |  |
BH-13d | Family MH Initial Outcome Tool | n/a | n/a | n/a |  |  |
BH-13e | Family MH Update Outcome Tool | n/a | n/a | n/a |  |  |
BH-13f | Family MH Discharge Outcome Tool | n/a | n/a | n/a |  |  |
BH-14 | Substance Abuse - Accreditation Application | n/a |  | n/a |  |  |
BH-17 | Prevention - Accreditation Application | n/a |  | n/a |  |  |
BH-18 | Substance Use Disorder High Intensity Referral Form | n/a |  | n/a |  |  |
BRO/BH1 | Substance Use Disorder Services Brochure | n/a | n/a | n/a |  |  |
BRO/BH2 | Mental Health Services Brochure | n/a | n/a | n/a |  |  |
BRO/BH3 | Quick Reference Guide | n/a |  | n/a | n/a | n/a |
MISC/BH1 | South Dakota Community Mental Health Center Flyer | n/a | n/a | n/a |  |  |
MISC/BH2 | Suicide Provention Poster | n/a | n/a | n/a |  |  |
MISC/BH3 | Substance Use Disorder Services Flyer | n/a | n/a | n/a |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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BRO/CCS14 | Choosing Child Care Handbook | n/a | n/a |  |  |  |
BRO/CCS3 | Registration & Licensure of Child Care Environments | n/a | n/a |  |  |  |
BRO/CCS6 | Child Care Assistance Program Brochure | n/a | n/a |  |  |  |
CCS | Pathways to Professional Development - Career Lattice Application Form | n/a | n/a | n/a |  |  |
CCS | Pathways to Professional Development - Renewal Application | n/a | n/a | n/a |  |  |
CCS | Orientation Training Verification Form | n/a | n/a | n/a |  |  |
CCS | South Dakota Child Safety Seat Distribution Program | n/a | n/a | n/a |  |  |
CCS | Electronic Payment Exemptions | n/a | n/a | n/a |  |  |
CCS | Payment Authorization Form | n/a | n/a | n/a |  |  |
CCS | Foster Care Child Care Application | n/a |  | n/a | n/a | n/a |
CCS-950 | Child Care Assistance Application | n/a |  | n/a |  |  |
CCS-964 | Child Care Declaration of Prior Criminal Conviction and Military History | n/a | n/a | n/a |  |  |
CCS-970 | Child Care Services Request For Payment | n/a | n/a | n/a |  |  |
DSS-CCS | Rate Declaration Form | n/a | n/a | n/a |  |  |
EA-269 | Child Care Expense Billing Information | n/a | n/a | n/a |  |  |
Poster | Recommendations for Exclusion from the Child Care Setting Poster | n/a | n/a | n/a |  |  |
Poster | Reportable Disease List Poster | n/a | n/a | n/a |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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BRO/CPS1 | Child Protection Services Booklet | n/a | n/a |  |  |  |
BRO/CPS15 | Family Group Conferencing – My Family Meeting | n/a | n/a | n/a |  |  |
BRO/CPS16 | Family Group Conferencing – Family Group Decision Making | n/a | n/a | n/a |  |  |
BRO/CPS17 | Family Group Conferencing – Parents Guide | n/a | n/a | n/a |  |  |
BRO/CPS18 | Family Group Conferencing – Provider Guide | n/a | n/a | n/a |  |  |
BRO/CPS3 | Safe Havens Brochure | n/a | n/a |  |  |  |
BRO/CPS7 | Independent Living Program Education and Training Voucher Brochure | n/a | n/a | n/a |  |  |
CPS | ICPC Financial and Medical Plan | n/a | n/a | n/a |  |  |
CPS | Potential Placement Statement | n/a | n/a | n/a |  |  |
CPS | Placement Resource Monthly Reporting Form Ages 0-4 | n/a | n/a | n/a |  |  |
CPS | Placement Resource Monthly Reporting Form Ages 14 and older | n/a | n/a | n/a |  |  |
CPS | Placement Resource Monthly Reporting Form Ages 5-13 | n/a | n/a | n/a |  |  |
CPS | Designated Tribal Agent Request Form | n/a | n/a | n/a |  |  |
CPS | Independent Living Program Brochure | n/a | n/a | n/a |  |  |
CPS | Provider Mileage Request | n/a | n/a | n/a |  |  |
CPS | Independent Living Program Education and Training Voucher |  | n/a | n/a |  |  |
CPS | Background Information for Voluntary Termination of Parental Rights | n/a | n/a | n/a |  |  |
CPS | Designated Tribal Agent Request for Change of Address | n/a | n/a | n/a |  |  |
CPS-500 | Newborn Medical Report for Voluntary Termination of Parental Rights | n/a |  | n/a |  |  |
CPS-522 | Request for Payment | n/a |  | n/a |  |  |
DSS-CPS | Safe Havens Poster | n/a | n/a | n/a |  |  |
FACIS | Interstate Compact: Placement Request Form |  |  | n/a |  |  |
FACIS | Interstate Compact: Report on Child Placement |  |  | n/a |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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BRO/DCS1 | Child Support Modification Handbook | n/a | n/a |  |  |  |
BRO/DCS2 | Teenage Parents Guide - How to Establish Paternity and Financial Support for your Child | n/a | n/a | n/a |  |  |
BRO/DCS3 | Income and Wage Withholding Brochure - Information for SD Employers, Financial Institutions, and Other Payors of Income | n/a | n/a | n/a |  |  |
BRO/DCS4 | National Medical Support Notice Brochure - An Employers Guide | n/a | n/a | n/a |  |  |
BRO/DCS6 | Voluntary Paternity Establishment Handbook and Form | n/a | n/a |  |  |  |
BRO/DCS8 | Child Support Parent Handbook | n/a | n/a |  |  |  |
SE-405 | Application for Income Withholding Only Service | n/a | n/a | n/a |  |  |
SE-406 | Application for Location Only Services | n/a | n/a | n/a |  |  |
SE408CP | Application and Agreement for Services - Custodial Parent and/or Caretaker | n/a | n/a | n/a |  |  |
SE408NCP | Application and Agreement for Services - Non-Custodial Parent | n/a | n/a | n/a |  |  |
SE-415 | Petition for Modification Form | n/a | n/a | n/a |  |  |
SE-431A | Child Support Payment Authorization Form | n/a | n/a | n/a |  |  |
SE-492 | Notice of Shared Medical Expenses | n/a | n/a | n/a |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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BRO/DSS2 | Constituent Liaison Services Brochure | n/a | n/a | n/a |  |  |
BRO/DSS6 | Filing a Discrimination Complaint Brochure and Form | n/a | n/a | n/a |  |  |
BRO/DSS8 | Notice of Privacy Brochure | n/a | n/a |  |  |  |
BRO/DSS9 | DSS Handbook | n/a | n/a | n/a |  |  |
BRO/EA | Community Action Agency Handout | n/a | n/a | n/a |  |  |
BRO/EA1 | Energy Saving Tips | n/a | n/a | n/a |  |  |
BRO/EA18 | Long-Term Care Partnership Brochure | n/a | n/a | n/a |  |  |
BRO/EA19 | Guide to Assistance Handbook | n/a | n/a | n/a |  |  |
DSS-W9 | W-9 Form | n/a | n/a | n/a |  |  |
EA-301 | Economic Assistance Application | n/a |  |  |  |  |
EA-310 | Form for Reporting Changes | n/a | n/a |  |  |  |
POS/EA02 | Long-Term Care Partnership Fact Sheet | n/a | n/a | n/a |  |  |
Poster | Constituent Liaison Services Poster | n/a | n/a | n/a |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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BRO/EA14 | Medical Assistance for Children and Families | n/a | n/a | n/a |  |  |
BRO/EA16 | Medical Assistance for Children and Families: IHS Specific | n/a | n/a | n/a |  |  |
BRO/EA5 | Medicare Savings Program Brochure | n/a | n/a | n/a |  |  |
BRO/EA8 | Medicaid Spousal Care Handbook | n/a | n/a | n/a |  |  |
BRO/MS1 | Medical Assistance Program Recipient Handbook | n/a | n/a |  |  |  |
EA-208 | Authorization to Furnish / Release Information | n/a | n/a |  |  |  |
EA-240 | Application for Resource Assessment, Long Term Care or Related Medical Assistance | n/a | n/a | n/a |  |  |
EA-240D | Application for Medical Assistance for Workers with Disabilities | n/a | n/a | n/a |  |  |
EA-265 | Request for Long-Term Care or Home Community Based Services Waiver Assistance | n/a | n/a | n/a |  |  |
EA-270 | Medical Savings Program Application | n/a | n/a |  |  |  |
EA-320 | Self-Employment Ledger | n/a | n/a |  |  |  |
FSSA | Children and Family Medical Assistance Application | n/a | n/a |  |  |  |
Poster | CHIP Poster | n/a | n/a | n/a |  |  |
Poster | CHIP Poster | n/a | n/a | n/a |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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| Recipient Forms: HIPAA Privacy Consent Form | n/a |  | n/a |  |  |
| Primary Care Provider Program Reminders - Emergency Room | n/a |  | n/a | n/a | n/a |
BRO/MS1 | Medical Assistance Program Recipient Handbook | n/a | n/a |  |  |  |
BRO/MS3 | Well-Child Care Brochure | n/a | n/a |  |  |  |
BRO/MS4 | Title XIX Medical Transportation Brochure | n/a | n/a | n/a |  |  |
BRO/MS6 | Health Home Brochure | n/a | n/a | n/a |  |  |
MS | Medicaid Transportation Documentation Form | n/a | n/a | n/a |  |  |
MS | Hysterectomy Acknowledgement of Information | n/a | n/a | n/a |  |  |
MS | Providers: NEMT Provider Agreement |  |  | n/a |  |  |
MS | Title XIX Non-Emergency Transportation Payment Authorization Form | n/a | n/a | n/a |  |  |
MS | Certificate of Medical Necessity | n/a | n/a | n/a |  |  |
MS | Transportation Exceptions Form | n/a | n/a | n/a |  |  |
MS | Providers: Adult Services & Aging Provider Agreement |  | n/a | n/a |  |  |
MS | Medicaid Credit Balance Report Form | n/a |  | n/a | n/a | n/a |
MS-102 | Provider Selection Form | n/a |  | n/a |  |  |
MS-103 | Provider Change Form | n/a |  | n/a |  |  |
MS-146 | Sterilization Consent Form | n/a | n/a | n/a |  |  |
OS-950 | Recipient Forms: Title XIX Medical Transportation Reimbursement | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Private Duty Nursing & Extended Home Health Services | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Out-of State Services | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Genetic Testing | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: BRCA | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Synagis | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Applied Behavior Analysis Therapy | n/a | n/a | n/a |  |  |
PA | Prior Authorization Forms: Durable Medical Equipment and Nutrition |  | n/a | n/a |  |  |
PA | Prior Authorization Forms: General |  | n/a | n/a |  |  |