You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number |
Name |
Effective Date |
---|---|---|---|
|
RSA-1312A | Authorization for Disclosure of Health Information to RSA | 07/01/2019 |
|
RSA-1312A-LP | Authorization for Disclosure of Health Information to RSA (Large Print) | 09/01/2022 |
|
PPP-1127A | Authorization for Disclosure of Protected Health Information | 01/01/2018 |
|
PPP-1127A-S | Authorization for Disclosure of Protected Health Information (Spanish) | 01/01/2018 |
|
DDD-0524A | Authorization for Release of Information (English) | 08/01/2019 |
|
DDD-0524A-S | Authorization for Release of Information (Spanish) | 08/01/2019 |
|
RSA-1313A | Authorization for Release of RSA Records | 05/01/2018 |
|
RSA-1313A-LP | Authorization for Release of RSA Records (Large Print) | 09/01/2022 |
|
DDD-2242A | Authorization for Transmission of Protected Health Information Via Unsecured Email | 09/01/2023 |
|
DDD-2172A | Authorization of Disclosure of Confidential Substance Use Disorder (SUD) Record Information | 02/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
DDD-1678A | Home Modifications Service Assessment (English) | 05/01/2023 |
|
DDD-0211A | Home Modifications Service Referral and Request (English) | 05/01/2023 |
|
LCR-1007A | Home Visit Report Supplement to Notice of Inspection and Due Process Rights | 07/01/2019 |
|
FAA-1459A | Hopi Tribal TANF Referral Notice | 06/01/2023 |
|
AAA-1122A | Host Agency Application | 08/01/2019 |
|
DDD-2098A | Hourly Nursing Assessment Tool (H-NAT) | 09/01/2021 |
|
DDD-1390A | Human Rights Committee Volunteer Application | 09/01/2022 |
|
GCI-1044A | IFSP Meeting Notification | 09/01/2023 |
|
GCI-1032A | IFSP Transition Meeting Invitation Prior Written Notice | 05/01/2023 |
|
FAA-1415A | Illegal Drug Use Statement (English) | 07/01/2023 |
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Pursuant to Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act (ADA) and other nondiscrimination laws and authorities, ADES does not discriminate on the basis of race, color, national origin, sex, age, or disability. Persons that require a reasonable modification based on language or disability should submit a request as early as possible to ensure the State has an opportunity to address the modification. The process for requesting a reasonable modification can be found at Equal Opportunity and Reasonable Modification