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Oklahoma Department of Human Services
Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd. • Oklahoma City, OK 73105
(405) 521-3646 • Fax (405) 521-6684 • Internet: www.okdhs.org

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Last Updated:  11/20/2007
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OKDHS Home > Library > Forms > Forms and Applications for Services
Library: Forms
OKDHS Forms
To view these forms, please choose the associated icon under the View column. In order to view the forms correctly, site guests may need additional software. In some cases, forms are saved as .pdf or .doc files. To take full advantage of the OKDHS content, get the latest versions of Adobe Acrobat Reader or Microsoft Word Viewer from the Downloads and Plug-ins page.
Formas
266 forms found    Page 1  2  3  4  5  6   
View Form No.Results shown in ascending orderLegacy No.Form Name Category
Open Request for Title XIX Nursing Assessment (.doc, 2 pp, 1132 KB)Open Request for Title XIX Nursing Assessment (.pdf, 2 pp, 151 KB)
02AG001E
ABCDM-083-ARequest for Title XIX Nursing AssessmentAging  
Medical  
Open Older Americans Act Assessment, Part I (.doc, 5 pp, 1.3 MB)Open Older Americans Act Assessment, Part I (.pdf, 5 pp, 243 KB)
02AG002E
AG-002-A, PART IOlder Americans Act Assessment, Part IAging  
Open Older Americans Act Assessment, Part II (.doc, 2 pp, 593 KB)Open Older Americans Act Assessment, Part II (.pdf, 2 pp, 75 KB)
02AG003E
AG-002-A, PART IIOlder Americans Act Assessment, Part IIAging  
Open Change of Client Status (.doc, 2 pp, 575 KB)Open Change of Client Status (.pdf, 2 pp, 166 KB)
02AG004E
AG-002-BChange of Client StatusAging  
Open Annual Assessment (.doc, 10 pp, 584 KB)Open Annual Assessment (.pdf, 10 pp, 202 KB)
02AG005E
AG-025Annual AssessmentAging  
Open Voluntary Withdrawal of Title III Project (.doc, 1 pp, 668 KB)Open Voluntary Withdrawal of Title III Project (.pdf, 1 pp, 128 KB)
02AG006E
AG-029Voluntary Withdrawal of Title III ProjectAging  
Open Equipment Inventory (.doc, 2 pp, 518 KB)
02AG013E
SUOA-S-016Equipment InventoryAging  
Open In-Kind Travel Expense Voucher (.doc, 1 pp, 1336 KB)Open In-Kind Travel Expense Voucher (.pdf, 1 pp, 201 KB)
02AG014E
SUOA-S-017In-Kind Travel Expense VoucherAging  
Open Nutrition Project Attendance Form (.doc, 2 pp, 757 KB)Open Nutrition Project Attendance Form (.pdf, 2 pp, 183 KB)
02AG016E
SUOA-S-032Nutrition Project Attendance FormAging  
Open Individual Attendance Record (.doc, 2 pp, 269 KB)
02AG017E
SUOA-S-033Individual Attendance RecordAging  
Open Project Menu Plan - Nutrition Program for the Elderly (.doc, 1 pp, 988 KB)Open Project Menu Plan - Nutrition Program for the Elderly (.pdf, 1 pp, 154 KB)
02AG018E
SUOA-S-034Project Menu Plan - Nutrition Program for the ElderlyAging  
Open Number of Meals Served (.doc, 2 pp, 985 KB)Open Number of Meals Served (.pdf, 2 pp, 1.7 MB)
02AG019E
SUOA-S-038Number of Meals ServedAging  
Open Area Agency on Aging (AAA) Quarterly Report (.doc, 3 pp, 1.1 MB)Open Area Agency on Aging (AAA) Quarterly Report (.pdf, 2 pp, 160 KB)
02AG020E
SUOA-S-054Area Agency on Aging (AAA) Quarterly ReportAging  
Open Area Agency on Aging (AAA) Quarterly Report - A (.pdf, 2 pp, 37 KB)
02AG021E
SUOA-S-054-AArea Agency on Aging (AAA) Quarterly Report - AAging  
Open Cumulative Program Performance Report (.doc, 1 pp, 765 KB)Open Cumulative Program Performance Report (.pdf, 1 pp, 218 KB)Open Cumulative Program Performance Report Instructions (.pdf, 1 pp, 31 KB)
02AG022E
SUOA-S-056-ACumulative Program Performance ReportAging  
Open Service Expenditures Profile (.doc, 2 pp, 721 KB)Open Service Expenditures Profile (.pdf, 2 pp, 336 KB)Open Service Expenditures Profile Instructions (.pdf, 1 pp, 22 KB)
02AG023E
SUOA-S-056-CService Expenditures ProfileAging  
Open Consumable Supplies Inventory (.doc, 1 pp, 624 KB)Open Consumable Supplies Inventory (.pdf, 1 pp, 165 KB)Open Consumable Supplies Inventory Instructions (.pdf, 1 pp, 30 KB)
02AG024E
SUOA-S-071Consumable Supplies InventoryAging  
Open Dietary Consultants Report (.doc, 1 pp, 574 KB)Open Dietary Consultants Report (.pdf, 1 pp, 176 KB)Open Dietary Consultants Report Instructions (.pdf, 1 pp, 19 KB)
02AG025E
SUOA-074Dietary Consultant's ReportAging  
Open Audit Report Transmittal (.doc, 1 pp, 1.5 MB)Open Audit Report Transmittal (.pdf, 1 pp, 230 KB)
02AG026E
SUOA-S-081Audit Report TransmittalAging  
Open Area Agency Quarterly Summary of Program Income (.doc, 1 pp, 147 KB)
02AG027E
SUOA-S-084Area Agency Quarterly Summary of Program IncomeAging  
Open Personal Care Plan (.doc, 4 pp, 92 KB)
02AG029E
AG-004Personal Care PlanAging  
Open Personal Care Planning Schedule (.doc, 1 pp, 1.5 MB)Open Personal Care Planning Schedule (.pdf, 4 pp, 299 KB)Open Personal Care Planning Schedule Instructions (.pdf, 1 pp, 27 KB)
02AG030E
AG-005Personal Care Planning ScheduleAging  
Open Personal Care (PC) Service Plan (.doc, 1 pp, 550 KB)Open Personal Care (PC) Service Plan (.pdf, 1 pp, 149 KB)Open Personal Care (PC) Service Plan Instructions (.pdf, 2 pp, 30 KB)
02AG031E
AG-006Personal Care (PC) Service PlanAging  
Open Personal Care Provider Communication (.doc, 1 pp, 515 KB)Open Personal Care Provider Communication (.pdf, 1 pp, 143 KB)
02AG032E
AG-007Personal Care Provider CommunicationAging  
Open Personal Care Agency Referral (.doc, 1 pp, 56 KB)
02AG033E
AG-008Personal Care Agency ReferralAging  
Open Personal Care Progress Notes (.doc, 2 pp, 228 KB)
02AG039E
AG-022Personal Care Progress NotesAging  
Open Personal Care Assistant (PCA) Supervisor Visit (.doc, 2 pp, 122 KB)Open Personal Care Assistant (PCA) Supervisor Visit (.pdf, 2 pp, 234 KB)
02AG040E
AG-022-APersonal Care Assistant (PCA) Supervisor VisitAging  
Open Documentation of Qualifications to Provide Personal Care Services (.doc, 2 pp, 140 KB)
02AG041E
AG-024Documentation of Qualifications to Provide Personal Care ServicesAging  
Open State Plan Personal Care (SPPC) Progress Notes (.doc, 4 pp, 993 KB)Open State Plan Personal Care (SPPC) Progress Notes (.pdf, 4 pp, 355 KB)
02AG044E
N/AState Plan Personal Care (SPPC) Progress NotesAging  
Open Adult Day Service Invoice (.doc, 1 pp, 82 KB)
02AS001E
ADM-012-ADS-SIAdult Day Service InvoiceAdult Day Services  
Aging  
Open Adult Day Services Referral/Application (.pdf, 3 pp, 163 KB)Open Adult Day Services Referral/Application Instructions (.pdf, 1 pp, 29 KB)
02AS003E
ADS-RA-001Adult Day Services Referral/ApplicationAging  
Applications  
Open Service/Attendance/Claim Record (.doc, 1 pp, 1.0 MB)
02AS004E
AS-ADS-001Service/Attendance/Claim RecordAdult Day Services  
Aging  
Open Older Americans Act - Title III Acronyms, 12/15/2003 (.pdf, 2 pp, 24 KB)
02AX001E
APPENDIX A-4Older Americans Act - Title III Acronyms, 12/15/2003Aging  
Appendices  
Open Title III Reports and Due Dates (.pdf, 2 pp, 62 KB)
02AX006E
APPENDIX C-21Title III Reports and Due DatesAging  
Appendices  
Open Directory - Congregate Meals Program (.pdf, 21 pp, 183 KB)
02AX007E
APPENDIX D-020Directory - Congregate Meals ProgramAging  
Appendices  
Open Job Descriptions for Older Americans Act Network Employees (.pdf, 61 pp, 274 KB)
02AX009E
APPENDIX M-014Job Descriptions for Older Americans Act Network EmployeesAging  
Appendices  
Open Eligibility Schedule/Rates for Adult Day Services (.pdf, 1 pp, 62 KB)
02AX010E
APPENDIX M-105Eligibility Schedule/Rates for Adult Day ServicesAdult Day Services  
Appendices  
Open Uniform Comprehensive Assessment (.doc. 5 pp. 1.4 MB)Open Uniform Comprehensive Assessment (.pdf, 5 pp, 363 KB)
02HM001E
AG-002, PART IUniform Comprehensive AssessmentAging  
Open Uniform Comprehensive Assessment (.doc, 4 pp, 601 KB)Open Uniform Comprehensive Assessment (.pdf, 3 pp, 263 KB)
02HM002E
AG-002, PART IIUniform Comprehensive AssessmentAging  
Open Uniform Comprehensive Assessment (.doc, 26 pp, 2.1 MB)Open Uniform Comprehensive Assessment (.pdf, 26 pp, 2169 KB)
02HM003E
AG-003, PART IIIUniform Comprehensive AssessmentAging  
Open Title III Services Program Report (.doc, 1 pp, 1.2 MB)Open Title III Services Program Report (.pdf, 18 pp, 112 KB)
02MP003E
SUOA-S-019Title III Services Program ReportAging  
Open Personal Care Client Freedom of Choice (.doc, 1 pp, 50 KB)
02MP005E
AG-010Personal Care Client Freedom of ChoiceAging  
Open Ombudsman Volunteer Application (.doc, 2 pp, 168 KB)Open Ombudsman Volunteer Application (.pdf, 2 pp, 125 KB)
02OM003E
SUOA-S-077Ombudsman Volunteer ApplicationAging  
Applications  
Open File Transfer (.doc, 1 pp, 170 KB)Open File Transfer (.pdf, 1 pp, 149 KB)
03AD002E
N/AFile TransferChild Support  
Open Interest Disclosure Notice (.doc, 2 pp, 914 KB)Open Interest Disclosure Notice (.pdf, 2 pp, 156 KB)
03AD003E
N/AInterest Disclosure NoticeChild Support  
Open Its All About Your Genes (.pdf, 1 pp, 90 KB)
03AX013E
APPENDIX CSED-13It's All About Your GenesAppendices  
Child Support  
Open Child Support Services and Responsibilities, 7/1/2007 ) (.pdf, 4 pp, 86 KB)
03AX016E
APPENDIX C-16Child Support Services and Responsibilities, 7/1/2007 )Appendices  
Child Support  
Open Application for Child Support Services (.doc, 18 pp, 1.6 MB)Open Application for Child Support Services (.pdf, 18 pp, 736 KB)
03EN001E
CSED-001Application for Child Support ServicesApplications  
Child Support  
Open Affidavit of Child Support Payments Received (.doc, 3 pp, 1.2 MB)Open Affidavit of Child Support Payments Received (.pdf, 3 pp, 185 KB)
03EN002E
CSED-1-AAffidavit of Child Support Payments ReceivedChild Support  
Open Summary of Support Order - English Version (.doc, 2 pp, 56 KB)Open Summary of Support Order - English Version (.pdf, 1 pp, 169 KB)
03EN003E
CSED-CCR SOSOSummary of Support Order - English VersionChild Support  
Page 1  2  3  4  5  6     
Oklahoma Department of Human Services
Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd., Oklahoma City, OK 73105
P.O. Box 25352, Oklahoma City, OK 73125
(405) 521-3646