Forms List
Links to forms used in this course are found below and on pages throughout the course at the time a form is referenced. Although you are not required to print these forms, you will need them available as you take the course. You may choose to gather the forms from your county forms supply, or print them from eDocs using the following links.
DHS-0029G Medical Assistance for Families with Children and Adults (MA-FCA) Income Eligibility (PDF).
DHS-1503 Physician Certification form (PDF).
DHS-2120 Household Report Form. (PDF)
DHS-6059A Medical Care Received (PDF).
DHS-6059B Medical Expense Tracking Worksheet for the LTC Income Calculation (PDF).
DHS-6059C Reported Medical Expense Notice of Action (PDF).
DHS-6112 MHCP Proof of Medical Need (PDF).
LTC Income Calculation Worksheet (PDF). This worksheet is not found in eDocs.
Page 3
Introduction