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
 
Library: Forms
OKDHS Forms
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Other Form Links
372 forms found    Page 1  2  3  4  5  6  7  8   
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, 321 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, 101 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, 186 KB)Open Change of Client Status Instructions (.pdf, 1 pp, 15 KB)
02AG004E
AG-002-BChange of Client StatusAging  
Open Annual Assessment (.doc, 10 pp, 584 KB)Open Annual Assessment (.pdf, 10 pp, 278 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, 190 KB)
02AG006E
AG-029Voluntary Withdrawal of Title III ProjectAging  
Open Cash Disbursements Journal (.xls, 1 pp, 148 KB)
02AG011E
SUOA-S-10Cash Disbursements JournalAging  
Open Cash Disbursements Journal (.xls, 182 KB)
02AG012E
SUOA-S-11Cash Disbursements JournalAging  
Open Equipment Inventory (.doc, 2 pp, 518 KB)Open Equipment Inventory (.pdf, 2 pp, 229 KB)
02AG013E
SUOA-S-16Equipment InventoryAging  
Open In-Kind Travel Expense Voucher (.doc, 1 pp, 1336 KB)Open In-Kind Travel Expense Voucher (.pdf, 1 pp, 354 KB)
02AG014E
SUOA-S-017In-Kind Travel Expense VoucherAging  
Open Organization Financial Report (.doc, 1 pp, 852 KB)Open Organization Financial Report (.pdf, 1 pp, 175 KB)Open Organization Financial Report Instructions (.pdf, 1 pp, 22 KB)
02AG015E
SUOA-S-20Organization Financial ReportAging  
Open Nutrition Project Attendance Form (.doc, 2 pp, 757 KB)Open Nutrition Project Attendance Form (.pdf, 2 pp, 237 KB)
02AG016E
SUOA-S-032Nutrition Project Attendance FormAging  
Open Individual Attendance Record (.doc, 2 pp, 269 KB)Open Individual Attendance Record (.pdf, 2 pp, 708 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, 175 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, 432 KB)Open Number of Meals Served Instructions (.pdf, 2 pp, 22 KB)
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, 181 KB)
02AG020E
SUOA-S-054Area Agency on Aging (AAA) Quarterly ReportAging  
Open Area Agency on Aging (AAA) Quarterly Report - A (.doc, 3 pp, 1.7 MB)Open Area Agency on Aging (AAA) Quarterly Report - A (.pdf, 3 pp, 497 KB)
02AG021E
SUOA-S-54-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, 246 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, 358 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, 187 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, 196 KB)Open Dietary Consultants Report Instructions (.pdf, 1 pp, 19 KB)
02AG025E
SUOA-074Dietary Consultant's ReportAging  
Open Audit Report Transmittal (.doc, 1 pp, 859 KB)Open Audit Report Transmittal (.pdf, 1 pp, 218 KB)
02AG026E
SUOA-S-081Audit Report TransmittalAging  
Open Area Agency Quarterly Summary of Program Income (.doc, 1 pp, 147 KB)Open Area Agency Quarterly Summary of Program Income (.pdf, 1 pp, 159 KB)
02AG027E
SUOA-S-084Area Agency Quarterly Summary of Program IncomeAging  
Open Management Plan (.doc, 1 pp, 679 KB)Open Management Plan (.pdf, 1 pp, 200 KB)
02AG028E
AG-030Management PlanAging  
Open Personal Care Plan (.doc, 4 pp, 92 KB)Open Personal Care Plan (.pdf, 4 pp, 172 KB)Open Personal Care Plan Instructions (.pdf, 1 pp, 14 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, 321 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, 866 KB)Open Personal Care (PC) Service Plan (.pdf, 1 pp, 154 KB)Open Personal Care (PC) Service Plan Instructions (.pdf, 2 pp, 23 KB)
02AG031E
AG-6Personal Care (PC) Service PlanAging  
Open Personal Care Provider Communication (.doc, 1 pp, 515 KB)Open Personal Care Provider Communication (.pdf, 1 pp, 163 KB)Open Personal Care Provider Communication Instructions (.pdf, 1 pp, 15 KB)
02AG032E
AG-007Personal Care Provider CommunicationAging  
Open Personal Care Agency Referral (.doc, 1 pp, 56 KB)Open Personal Care Agency Referral (.pdf, 1 pp, 130 KB)
02AG033E
AG-008Personal Care Agency ReferralAging  
Open Documentation of Qualifications to Provide Personal Care Services (.doc, 2 pp, 140 KB)Open Documentation of Qualifications to Provide Personal Care Services (.pdf, 2 pp, 267 KB)Open Documentation of Qualifications to Provide Personal Care Services Instructions (.pdf, 1 pp, 19 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, 416 KB)
02AG044E
N/AState Plan Personal Care (SPPC) Progress NotesAging  
Open Recruitment Incident Report (.doc, 2 pp, 674 KB)Open Recruitment Incident Report (.pdf, 2 pp, 144 KB)
02AG047E
N/ARecruitment Incident ReportAging  
Open Notice to Comply (.doc, 2 pp, 661 KB)Open Notice to Comply (.pdf, 2 pp, 140 KB)
02AG048E
N/ANotice to ComplyAging  
Open Adult Day Service Invoice (.doc, 1 pp, 82 KB)Open Adult Day Service Invoice (.pdf, 1 pp, 119 KB)Open Adult Day Service Invoice Instructions (.pdf, 2 pp, 16 KB)
02AS001E
ADM-012-ADS-SIAdult Day Service Invoice Adult Day Services  
Aging  
Open Adult Day Services Monthly Report (.doc, 2 pp, 1.0 MB)Open Adult Day Services Monthly Report (.pdf, 2 pp, 174 KB)
02AS002E
ADS-MR-1Adult Day Services Monthly ReportAdult Day Services  
Open Adult Day Services Referral/Application (.doc, 3 pp, 664 KB)Open Adult Day Services Referral/Application (.pdf, 3 pp, 184 KB)Open Adult Day Services Referral/Application Instructions (.pdf, 1 pp, 16 KB)
02AS003E
ADS-RA-1Adult Day Services Referral/ApplicationAdult Day Services  
Aging  
Applications  
Open Service/Attendance/Claim Record (.doc, 1 pp, 1.0 MB)Open Service/Attendance/Claim Record (.pdf, 1 pp, 711 KB)Open Service/Attendance/Claim Record Instructions (.pdf, 1 pp, 20 MB)
02AS004E
AS-ADS-001Service/Attendance/Claim RecordAdult Day Services  
Aging  
Open Member Consents and Rights (.pdf, 2 pp, 571 KB)
02CB001E
N/AMember Consents and RightsAdvantage  
Open Service Team Release of Information (.pdf, 2 pp, 694 KB)
02CB005E
ADV5Service Team Release of InformationAdvantage  
Open Provider Communication (.doc, 1 pp, 245 KB)Open Provider Communication (.pdf, 1 pp, 151 KB)Open Provider Communication Instructions (.pdf, 1 pp, 18 KB)
02CB009E
ADV9Provider CommunicationAdvantage  
Open Member Change of Provider (.doc, 2 pp, 256 KB)Open Member Change of Provider (.pdf, 2 pp, 217 KB)Open Member Change of Provider Instructions (.pdf, 1 pp, 36 KB)
02CB010E
ADV10Member Change of ProviderAdvantage  
Open Service Plan Cost Sheet (.doc, 2 pp, 281 KB)Open Service Plan Cost Sheet (.pdf, 2 pp, 286 KB)Open Service Plan Cost Sheet Instructions (.pdf, 2 pp, 27 KB)
02CB011E
ADV6EService Plan Cost SheetAdvantage  
Open Service Plan Cost Sheet Addendum (.doc, 2 pp, 268 KB)Open Service Plan Cost Sheet Addendum (.pdf, 2 pp, 210 KB)Open Service Plan Cost Sheet Addendum Instructions (.pdf, 4 pp, 35 KB)
02CB012E
ADV6E1Service Plan Cost Sheet AddendumAdvantage  
Open Service Plan Goals (.doc, 6 pp, 279 KB)Open Service Plan Goals (.pdf, 6 pp, 274 KB)Open Service Plan Goals Instructions (.pdf, 2 pp, 18 KB)
02CB013E
N/AService Plan GoalsAdvantage  
Open Services Backup Plan (.doc, 2 pp, 287 KB)Open Services Backup Plan (.pdf, 2 pp, 260 KB)Open Services Backup Plan Instructions (.pdf, 2 pp, 31 KB)
02CB014E
ADV300Services Backup PlanAdvantage  
Open Discharge Evaluation (.pdf, 2 pp, 151 KB)
02CB015E
ADV15Discharge EvaluationAdvantage  
Open Notice of Change in ADvantage Services (.pdf, 1 pp, 156 KB)
02CB016E
N/ANotice of Change in ADvantage ServicesAdvantage  
Open Member Negotiated Risk Agreement (.pdf, 2 pp, 691 KB)
02CB024E
N/AMember Negotiated Risk AgreementAdvantage  
Open Service Provider Safety Agreement (.pdf, 2 pp, 695 KB)
02CB025E
N/AService Provider Safety AgreementAdvantage  
Open Environmental Modification Decision Tool (.doc, 2 pp, 918 KB)Open Environmental Modification Decision Tool (.pdf, 2 pp, 253 KB)Open Environmental Modification Decision Tool Instructions (.pdf, 2 pp, 19 KB)
02CB031E
N/AEnvironmental Modification Decision ToolAdvantage  
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Last Updated:  7/22/2014