DHS Forms

The section below contains blank DHS Forms you can download, complete, and return when needed.
Type Language Action
DHS 8003 - INSTRUCTIONS English
DHS 8004 - INSTRUCTIONS English
DHS 8004 - ANNUAL HOME EQUITY SURVEY FOR LONG-TERM CARE BENEFICIARIES English
DHS 8003 - REPORTING REQUIREMENTS FOR INDIVIDUALS REQUESTING RECEIVING COVERAGE OF LONG-TERM CARE SERVICES WITH ANNUITIES English
DHS 1179A - INSTRUCTIONS English
DHS 1124 - AUTHORIZATION TO DISCLOSE CONFIDENTIAL INFORMATION TO THE MED-QUEST DIVISION English
DHS 1169A - MAINTENANCE OF LIEN STATUS English
DHS 1163 - DEATH PAYMENTS PROGRAM APPLICATION English
DHS 1127 - MEDICAL HISTORY AND DISABILITY STATEMENT English
DHS 1179A - CHANGE OF CIRCUMSTANCE REPORT FORM English
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