Their mission is to assist Pennsylvanians in leading safe, healthy, and productive lives through equitable, trauma-informed, and outcome-focused services while being an accountable steward of commonwealth resources.
Forms & Documents
Browse all Department of Human Services government forms
81 - 100 of 338 forms
| Form Title | Topics |
|---|---|
| Certification of Terminal Illness | Personal Care Home, Order Medical Assistance |
| Cesamet Form | Personal Care Home, Pharmacy Services Fax |
| Change of Hospice Provider | Personal Care Home, Order Medical Assistance |
| Child Care Employment Verification Form | Child Care |
| Child Care Staff Data Worksheet | Child Care |
| Child Health Assessment | Child Care |
| Child Service Report | Child Care |
| Cholbam Form | Personal Care Home, Pharmacy Services Fax |
| Cimzia Form | Personal Care Home, Pharmacy Services Fax |
| Citizenship and Identity Information | Personal Care Home, Order Medical Assistance |
| Civil Rights Compliance Questionnaire Central Northern Region | Personal Care Home, Personal Care Homes Application For Licensure |
| Civil Rights Compliance Questionnaire Southeastern Region | Personal Care Home, Personal Care Homes Application For Licensure |
| Civil Rights Compliance Questionnaire Western Region HS 2029.1 | Personal Care Home, Personal Care Homes Application For Licensure |
| CMS-1500 Commercial Insurance Attachment | Personal Care Home, Order Medical Assistance |
| CMS-1500 Medicare Attachment | Personal Care Home, Order Medical Assistance |
| Colony Stimulating Factors Form | Personal Care Home, Pharmacy Services Fax |
| Compounded Prescriptions Form | Personal Care Home, Pharmacy Services Fax |
| Consent for Voluntary Inpatient Treatment | Personal Care Home, Mental Health Provider |
| Consent for Voluntary Inpatient Treatment | Personal Care Home, Mental Health Provider |
| Consent/Release of Information Authorization Form | Child Care |
Contact Information & Office Locations
All 11 contact points
Allentown Office
Address:
555 Union Blvd
Allentown, PA 18109-3389
- (610) 861-2000
- RA-RV-BET-BET-DO-EM@pa.gov
Erie Office
Address:
448 W 11th st
Erie, PA 16501-1501
- (814) 871-4491
- v
Greensburg Office
Address:
Second Floor
15 W Third st
Greensburg, 15601-3003
- (724) 832-5283
- RA-RV-BET-GBG-DO-EM@pa.gov
Harrisburg Office
Address:
Lobby
Strawberry sq
Harrisburg, PA 17128-0101
- (717) 783-1405
- RA-RV-BET-HBG-TA-EM@pa.gov
Norristown Office
Address:
Second fl ste 210
Stony Creek Office Center
151 W Marshall St
Norristown, PA 19401-4739
- (610) 270-1780
- RA-RV-BET-NOR-DO-EM@pa.gov
Philadelphia - Center City Office
Address:
STE 204A (Inheritance Tax Office in Suite 204B)
110 N 8TH ST
Philadelphia, PA 19107-2412
- (215) 560-2056
- RA-RV-BET-PHI-TA-EM@pa.gov
Philadelphia - Northeast Office
Address:
ACDMY PLZ Shpg Ctr
3240 Red Lion rd
Philadelphia, 19114-1109
- (215) 821-1860
- RA-RV-BET-PNE-DO-EM@pa.gov
Pittsburgh - Downtown Office
Address:
411 7th Ave room 420
Pittsburgh, PA 15219-1905
- (412) 565-7540
- RA-RV-BET-PGH-TA-EM@pa.gov
Pittsburgh - Greentree Office
Address:
11 Parkway Ctr ste 175
Pittsburgh, PA 15220
- (412) 929-0614
- RA-RV-BET-GTR-DO-EM@pa.gov
Reading Office
Address:
STE 239
625 Cherry St
Reading, PA 19602-1186
- (610) 378-4401
- RA-RV-BET-RDG-DO-EM@pa.gov
Scranton Office
Address:
Bank Towers
207 Wyoming Ave
Room 207
Scranton, PA 18503-1427
- (570) 963-4585
- RA-RV-BET-SCR-DO-EM@pa.gov