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Oklahoma Department of Human Services
Oklahoma Department of Human Services
Stronger Families Grow Brighter Futures
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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OKDHS Home > Library > Forms > Forms and Applications for Services
Library: Forms
OKDHS Forms
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Other Form Links
51 forms found    Page 1  2   
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, 196 KB)
02AG001E
ABCDM-083-ARequest for Title XIX Nursing AssessmentAging  
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 Instructions (.pdf, 2 pp, 16 KB)
02AS001E
ADM-012-ADS-SIAdult Day Service Invoice Aging  
Open Adult Day Services Referral/Application (.doc, 3 pp, 664 KB)Open Adult Day Services Referral/Application (.pdf, 3 pp, 204 KB)Open Adult Day Services Referral/Application Instructions (.pdf, 1 pp, 16 KB)
02AS003E
ADS-RA-001Adult Day Services Referral/ApplicationAging  
Open Service/Attendance/Claim Record (.doc, 1 pp, 1.0 MB)
02AS004E
AS-ADS-001Service/Attendance/Claim RecordAging  
Open Uniform Comprehensive Assessment (.doc. 5 pp. 1.4 MB)Open Uniform Comprehensive Assessment (.pdf, 5 pp, 386 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, 2.3 MB)
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, 132 KB)
02MP003E
SUOA-S-019Title III Services Program ReportAging  
Open Personal Care Client Freedom of Choice (.doc, 1 pp, 50 KB)Open Title III Services Program Report (.pdf, 1 pp, 124 KB)Open Personal Care Client Freedom of Choice Instructions (.pdf, 1 pp, 27 KB)
02MP005E
SUOA-S-019Title III Services Program ReportAging  
Open Ombudsman Volunteer Application (.doc, 2 pp, 677 KB)Open Ombudsman Volunteer Application (.pdf, 2 pp, 178 KB)
02OM003E
SUOA-S-77Ombudsman Volunteer ApplicationAging  
Open Notification Regarding Patient in a Nursing Facility (NF), Intermediate Care Facility for the Mentally Retarded (ICF/MR), or Hospice (.pdf, 2 pp, 175 KB)
08MA083E
ABCDM-083Notification Regarding Patient in a Nursing Facility (NF), Intermediate Care Facility for the Mentally Retarded (ICF/MR), or HospiceAging  
Open Management of Recipients Funds (.pdf, 2 pp, 81 KB)
08MA084E
ABCDM-096Management of Recipient's FundsAging  
Open Accounting - Recipients Personal Funds and Property (.doc, 1 pp, 667 KB)Open Accounting - Recipients Personal Funds and Property Instructions (.pdf, 1 pp, 23 KB)
08MA085E
ABCDM-96-AAccounting - Recipient's Personal Funds and Property Aging  
Open Older Americans Act - Title III Acronyms, 12/15/2003 (.pdf, 2 pp, 27 KB)
A-4
02AX001EOlder Americans Act - Title III Acronyms, 12/15/2003Aging  
Open Long-Term Care (LTC) Services (.pdf, 2 pp, 141 KB)
A-7
02AX004ELong-Term Care (LTC) ServicesAging  
Open Eligibility Requirements for Long-Term Care Programs (.pdf, 2 pp, 45 KB)
A-8
02AX005EEligibility Requirements for Long-Term Care ProgramsAging  
Open Title III Reports Schedule (.pdf, 2 pp, 74 KB)
C-21
02AX006ETitle III Reports ScheduleAging  
Open Directory - Congregate Meals Program 09/10/09 (.pdf, 30 pp, 589 KB)
D-20
02AX007EDirectory - Congregate Meals Program 09/10/09Aging  
Page 1  2     


Last Updated:  5/17/2013
Oklahoma Department of Human Services
Street address: Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd., Oklahoma City, OK 73105
Mailing address: P.O. Box 25352, Oklahoma City, OK 73125
(405) 521-3646
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