Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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CCS | Electronic Payment Exemptions | n/a |  | n/a | n/a | n/a |
CCS | Payment Authorization Form | n/a |  | n/a | n/a | n/a |
CCS | Foster Care Child Care Application | n/a |  | n/a | n/a | n/a |
CCS | Pathways to Professional Development - Renewal Application | n/a |  | n/a | n/a | n/a |
CCS | Pathways to Professional Development - Career Lattice Application Form | n/a |  | n/a | n/a | n/a |
CCS-950 | Child Care Assistance Application | n/a |  |  |  |  |
CCS-970 | Child Care Services Request For Payment | n/a |  | n/a |  |  |
DSS-CCS | Rate Declaration Form | n/a | n/a | n/a |  |  |
OLA-100 | Background Screening Information Authorization | n/a |  | n/a | n/a | n/a |
OLA-101 | Orientation Training Verification Form | n/a |  | n/a | n/a | n/a |
OLA-103 | Child Care Declaration of Prior Criminal Conviction and Military History | n/a |  | n/a | n/a | n/a |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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CPS | Background Information for Voluntary Termination of Parental Rights | n/a |  | n/a | n/a | n/a |
CPS | ICPC Financial and Medical Plan | n/a |  | n/a | n/a | n/a |
CPS | Potential Placement Statement | n/a |  | n/a | n/a | n/a |
CPS | Provider Mileage Request | n/a |  | n/a | n/a | n/a |
CPS | Designated Tribal Agent Request Form | n/a |  | n/a | n/a | n/a |
CPS | Designated Tribal Agent Request for Change of Address | n/a |  | n/a | n/a | n/a |
CPS-100 | Independent Living Program Education and Training Voucher |  |  | n/a | n/a | n/a |
CPS-100A | FACIS Interstate Compact: Placement Request Form |  |  | n/a | n/a | n/a |
CPS-100B | FACIS Interstate Compact: Report on Child Placement |  |  | n/a | n/a | n/a |
CPS-500 | Newborn Medical Report for Voluntary Termination of Parental Rights | n/a |  | n/a | n/a | n/a |
CPS-522 | Request for Payment | n/a |  | n/a |  |  |
Doc # | Document Name | Instructions | Online Version | Spanish Version | English Version | Add to Cart |
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MS-100 | Recipient Forms: HIPAA Privacy Consent Form | n/a |  | n/a | n/a | n/a |
MS-102 | Provider Selection Form | n/a |  | n/a | n/a | n/a |
MS-103 | Provider Change Form | n/a |  | n/a | n/a | n/a |
MS-113 | Dental At-Risk Referral Form | n/a |  | n/a | n/a | n/a |
MS-114 | South Dakota Medicaid Pre-Orthodontic Certification Form | n/a |  | n/a | n/a | n/a |
MS-115 | South Dakota Medicaid Handicapping Labio-Langual Deviations Form (HLD Index) | n/a |  | n/a | n/a | n/a |
MS-116 | Medicaid Credit Balance Report Form | n/a |  | n/a | n/a | n/a |
MS-117 | Hysterectomy Acknowledgement of Information | n/a |  | n/a | n/a | n/a |
MS-118 | Medicaid Transportation Documentation Form | n/a |  | n/a | n/a | n/a |
MS-119 | Certificate of Medical Necessity | n/a |  | n/a | n/a | n/a |
MS-120 | Transportation Exceptions Form | n/a |  | n/a | n/a | n/a |
MS-122 | Health Home Selection and Change Form | n/a |  | n/a | n/a | n/a |
MS-123 | Health Home Decline to Participate Form | n/a |  | n/a | n/a | n/a |
MS-124 | Community Mental Health Center Health Home Referral Form | n/a |  | n/a | n/a | n/a |
MS-125 | Health Home Referral Form | n/a |  | n/a | n/a | n/a |
MS-126 | Health Home Manual Tiering Document | n/a |  | n/a | n/a | n/a |
MS-127 | Health Home Application | n/a |  | n/a | n/a | n/a |
MS-128 | Health Home Application Attestation | n/a |  | n/a | n/a | n/a |
MS-146 | Sterilization Consent Form | n/a |  |  | n/a | n/a |
NEMT-952 | Medicaid Non-Emergency Travel (NEMT) Payment Authorization Form | n/a |  |  | n/a | n/a |
PA-100 | Prior Authorization Forms: General | n/a |  | n/a | n/a | n/a |
PA-101 | Prior Authorization Forms: Durable Medical Equipment and Nutrition | n/a |  | n/a | n/a | n/a |
PA-102 | Prior Authorization Forms: Applied Behavior Analysis Therapy | n/a |  | n/a | n/a | n/a |
PA-103 | Prior Authorization Forms: Synagis | n/a |  | n/a | n/a | n/a |
PA-104 | Prior Authorization Forms: Private Duty Nursing & Extended Home Health Services | n/a |  | n/a | n/a | n/a |
PA-105 | Prior Authorization Forms: Out-of-State Services | n/a |  | n/a | n/a | n/a |
PA-106 | Prior Authorization Forms: Genetic Testing | n/a |  | n/a | n/a | n/a |
PA-107 | Prior Authorization Forms: BRCA | n/a |  | n/a | n/a | n/a |
PA-108 | Prior Authorization Form: Incontinence Supply Family Support 360 Waiver | n/a |  | n/a | n/a | n/a |
PA-109 | Prior Authorization Form: Incontinence Supply HOPE Waiver | n/a |  | n/a | n/a | n/a |
PA-110 | Prior Authorization Form: Incontinence Supply ADLS Waiver | n/a |  | n/a | n/a | n/a |
PA-111 | Prior Authorization Form: Incontinence Supply CHOICES Waiver | n/a |  | n/a | n/a | n/a |