Lynne A. Valenti
Cabinet Secretary

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Below you will find the selected forms and/or publications for this order. You will need to indicate the quantity you want to receive in the box next to the document number. After you have entered the quantity, click "Update" in the previous box. If you wish to remove a form or publication, simply click on the link that states "Delete." Once you have entered the quantity for each form or publication, click the "Proceed" button at the bottom.

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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditPAPrior Authorization Forms: Out-of State Services Delete
1EditOS-950Recipient Forms: Title XIX Medical Transportation ReimbursementDelete
1EditBRO/ASA10Planning for Health Care Decisions: Your Right to ChooseDelete
1EditBRO/EA9SNAP Shoppers GuideDelete
1EditBRO/DSS8Notice of Privacy BrochureDelete
1EditBRO/DCS6Voluntary Paternity Establishment Handbook and FormDelete
1EditBRO/ASA2Abuse, Neglect & Exploitation of Elders or Adults with DisabilitiesDelete
1EditBRO/CPS15Family Group Conferencing – My Family Meeting Delete
1EditBRO/DCS4National Medical Support Notice Brochure - An Employers GuideDelete
1EditBRO/EBT1EBT Client HandbookDelete
1EditDSS-CCSRate Declaration FormDelete
1EditMISC/ASA6Assisted Living in SD: A Consumers GuideDelete
1EditBRO/RE3Estate Recovery Program BrochureDelete
1EditMSTitle XIX Non-Emergency Transportation Payment Authorization FormDelete
1EditBRO/CPS18Family Group Conferencing – Provider Guide Delete
1EditCPS-522Request for PaymentDelete
1EditBRO/EA5Medicare Savings Program BrochureDelete
1EditMSPrior Authorization Forms: Synagis Prior AuthorizationDelete
1EditCCS-950Child Care Assistance ApplicationDelete
1EditBRO/ASA1Aging & Disability Resource Connections (ADRC)Delete
1EditEA-269Recipient Forms: Child Care Expense Billing InformationDelete
1EditRec and FraudStop Benefit Fraud InsertDelete
1EditASA-694Crime Victims Compensation ApplicationDelete
1EditRec and FraudEstate Recovery Program Petition for LimitationDelete
1EditCCSPayment Authorization FormDelete
1EditBRO/ASA4Sexual Assault BrochureDelete