Department of Health and Social Services

Official Website: http://dhss.alaska.gov

The mission of the Department of Health and Social Services is to "promote and protect the health and well-being of Alaskans."

Provides to all eligible Alaskans access and oversight to the full range of appropriate Medicaid services. We also protect Alaska’s most vulnerable populations through our certification and licensing sections.

Forms & Documents

Browse all Department of Health and Social Services government forms

1 - 20 of 112 forms

Form Title Topics
14B CFC Services Overview and Cost Sheet
ALI/APDD/CCMC Initial Application Checklist
ALI/APDD/CCMC Renewal Application Checklist
Amendment to Service Plan
Application for ALI/APDD/CCMC/CFC
Application for Community First Choice Personal Care Services When Traveling
Application for Personal Care Service When Traveling
Appointment for Care Coordinator/Targeted Case Management Services (revised 7/23/19)
Authorization for Release of Information
Care Coordination Agency Certification Conflict of Interest Attestation
Care Coordination Request for Visit Exception
Care Coordinator Certification Application
Care Coordinator Disclosure of Business and Familial Relationships
CFC Only Initial Application Checklist
CFC Only Renewal Application Checklist
Conflict of Interest Exception Application
Consent Form for Telehealth Assessment
Consumer/Legal Representative Agreement
Developmental Disa?bilities Registration and Review??
DHSS Table of ICAP scores

Contact Information & Office Locations

All 3 contact points

Main Office

Address:
350 Main Street
Room 404
PO Box 110601
Juneau, AK 99811-0601

Phone numbers:
  • (907) 465-3030

Address:
Administration
P.O. Box 110620
Juneau, AK 99811-0620

Phone numbers:
  • (907) 465-8202
Fax numbers:
  • (907) 465-2185

Address:
Behavioral Health Office
3601 C Street
Suite 878
Anchorage, AK 99503

Phone numbers:
  • (907) 269-3600
Fax numbers:
  • (907) 269-3623

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