Skip to main content
Georgia Department of Community Health logo Georgia MMIS
Search
  Friday, March 29, 2024
Skip to Provider Information Subsystem Menu

  Bookmark star  <- Bookmarkable Link   Bookmark star and question mark Click here for help and information about bookmarks

»

User Information

  
Login/Manage Account
Login

PDF Reader Required
NOTE: If you don't have a PDF reader already installed, Adobe Acrobat Reader is required to view these documents. Click here to obtain the latest version of the free Adobe Reader.
File Download Issues
Some users may have difficulty downloading files. Often this is caused by pop-up windows being blocked or by security settings in the browser. Click here for help with download issues.
go

Forms (more than 150 available) List
 
»

Forms (more than 150 available)

 
 TitleFile TypeCategorySize (KB)Release Date 
00 - EDWP - CCSP and SOURCE Documents ManualPDFEDWP CASE MGMT101.403/16/2023 
01 - EDWP Client Brochure - EnglishPDFEDWP CASE MGMT107.411/29/2023 
02 - EDWP Client Brochure - KoreanPDFEDWP CASE MGMT221.111/29/2023 
03 - EDWP Client Brochure - SpanishPDFEDWP CASE MGMT47.811/29/2023 
04 - EDWP SOURCE AND CCSP Case Managers ListPDFEDWP CASE MGMT27503/11/2024 
05 - Form 5383 - Request For HearingPDFEDWP CASE MGMT416802/01/2023 
06 - Level of Care Denial Letter (ADRC)PDFEDWP CASE MGMT721.802/01/2023 
07 - Change in Service - No Reassessment Cover Letter - ElectronicPDFEDWP CASE MGMT93.606/29/2023 
07 - Change in Service - No Reassessment Cover Letter - PaperPDFEDWP CASE MGMT115.902/01/2023 
08 - Level Of Care Cover LetterPDFEDWP CASE MGMT1441.402/01/2023 
09 - FORM 5382 - Notice Of Denial, Termination, or Reduction in Service - ElectronicPDFEDWP CASE MGMT2602/01/2023 
09 - FORM 5382 - Notice Of Denial, Termination, or Reduction in Service - PaperPDFEDWP CASE MGMT761.502/01/2023 
10 - Notice of Status of Request for Service from the CCSPPDFEDWP CASE MGMT68702/01/2023 
11 - Form 5588 - Level of Care Placement FormPDFEDWP CASE MGMT303.305/19/2023 
11 - Form 5588 - Level of Care Placement Form - InstructionsPDFEDWP CASE MGMT222.103/14/2024 
12 - Level of Care Criteria CrosswalkPDFEDWP CASE MGMT153.902/01/2023 
13 - Authorization for Release of Information & Informed Consent PDFEDWP CASE MGMT126.305/04/2023 
13 - Authorization for Release of Information & Informed Consent - InstructionsPDFEDWP CASE MGMT117.202/01/2023 
14 - Form 5459 - Authorization for Release of Information - ElectronicPDFEDWP CASE MGMT37.302/01/2023 
14 - Form 5459 - Authorization for Release of Information - InstructionsPDFEDWP CASE MGMT115.402/01/2023 
14 - Form 5459 - Authorization for Release of Information - PaperPDFEDWP CASE MGMT45.602/01/2023 
15 - HIPAA - DCH Privacy NoticePDFEDWP CASE MGMT161.610/10/2023 
16 - HDM Client Referral/Evaluation Form - ElectronicPDFEDWP CASE MGMT103.602/01/2023 
16 - HDM Client Referral/Evaluation Form - PaperPDFEDWP CASE MGMT704.402/01/2023 
17 - Rights and Responsibilities PDFEDWP CASE MGMT68.601/26/2024 
18 - EDWP Community Care Communicator PDFEDWP CASE MGMT175.502/01/2023 
19 - Form 5389 - EDWP Program ParticipationPDFEDWP CASE MGMT56.602/01/2023 
20 - Cost ReviewPDFEDWP CASE MGMT14202/01/2023 
21 - Form 5381 - Notice of Right to AppealPDFEDWP CASE MGMT638.902/01/2023 
22 - Nutritional Screening Initiative (NSI) - ChecklistPDFEDWP CASE MGMT147.302/01/2023 
23 - PMAO EDWP Medicaid Financial WorksheetPDFEDWP CASE MGMT668.502/01/2023 
24 - APS HFR Folder Info SheetPDFEDWP CASE MGMT151.802/01/2023 
25 - Physician Evaluation FormPDFEDWP CASE MGMT188.602/01/2023 
26 - Appendix DD/Nursing Supervisory Visit FormPDFEDWP CASE MGMT1952.104/05/2023 
27 - Defining ECMPDFEDWP CASE MGMT198.902/01/2023 
28 - ECM DM Physician Letter CCSPPDFEDWP CASE MGMT110.102/01/2023 
29 - EDWP - Consumer Directed PSS Option - Fact SheetPDFEDWP CASE MGMT139.202/01/2023 
30 - CD PSS - Client Participation AgreementPDFEDWP CASE MGMT123.203/11/2024 
31 - CD PSS - Employee Task ListPDFEDWP CASE MGMT343.502/01/2023 
32 - CD PSS - Recruit Hire Conflict Mediation - Fact SheetPDFEDWP CASE MGMT107.902/01/2023 
33 - CD PSS - Skills Inventory - Training ChecklistPDFEDWP CASE MGMT161.402/01/2023 
35 - Member Choice Form - ADRCPDFEDWP CASE MGMT59.302/01/2023 
35 - Member Choice Form - ADRC - InstructionsPDFEDWP CASE MGMT6002/01/2023 
36 - Member Choice Form - ADRC - SpanishPDFEDWP CASE MGMT18.102/01/2023 
37 - Member Choice Form - ADRC - KoreanPDFEDWP CASE MGMT80.802/01/2023 
38 - Member Choice Form - CCPDFEDWP CASE MGMT62.802/01/2023 
39 - EDWP Notification FormPDFEDWP CASE MGMT92.902/01/2023 
39 - EDWP Notification Form - InstructionsPDFEDWP CASE MGMT64.702/01/2023 
40 - Transfer Form - ElectronicPDFEDWP CASE MGMT220.511/01/2023 
41 - MDS Assessment (HC-9)PDFEDWP CASE MGMT1282.102/01/2023 
1 2 3 ...
English | EspaƱol | Accessibility | Privacy | AMA & ADA Copyright Report Fraud
© Copyright 2024 Gainwell Technologies