Health and Human Services Forms

On this page:

Consumer Forms	Provider Forms
Application Forms Information/Publications Request Health Adults with Cognitive & Physical Disabilities Forms Mental Health Children's Behavioral Health Contact and Feedback	Substance Abuse Adults with Cognitive & Physical Disabilities Children's Behavioral Health Behavioral Health Health Environmental Health Mental Health Licensing and Regulatory Miscellaneous

Provider Forms

Substance Abuse Forms

OSA Forms

OSA DEEP Forms

OSA Treatment Forms

OSA Provider Prevention Forms

OSA Treatment Data Systems Forms

OSA Fiscal and Contract Forms

OSA Safe and Drug Free Schools and Communities

Alcohol and Drug Treatment Program Application - Application for Licensure and Certification of Substance Abuse Treatment Program

Adults with Cognitive & Physical Disabilities Forms

Developmental Services Case Management Forms

Application for Certification as Provider of Section 13.05, Targareted Case Management Services

PCP Forms

Developmental Services Forms

Provider Resource Directory Information Forms

Behavioral Regulations/Three Person Committee Forms

Support waiver

Annual Room, Board, and Occupancy Subsidy

Children's Behavioral Health Forms

Children's Behavioral Health Provider Forms

State wide ITRT form

Flexible funds forms

Behavioral Health Provider Resource Directory Forms

Behavioral Health Forms

EIS Resource Access Forms

EIS Data Modification Forms

EIS Behavioral Health Forms

EIS Computer Based Training Form

EIS Online Report Request Form

Behavioral Health Web Site Editorial Change Form

Behavioral Health HIPAA Forms

Health Forms

Disease Reporting

Maine Occupational Disease Reporting Form

Infectious Disease Epidemiology Program - Request for Data

Maine Breast and Cervical Health Program Forms

Maine Immunization Program Forms

Pandemic Influenza Survey Form

Infectious Disease Epidemiology Program Request for Data Form

BIAT/SOC Elder Services Provider Forms

MaineCare Home Health Forms

Elder Services Online Request to Add a Web Site

Nursing Facilities Provider Forms

Private Duty Nursing

Private Duty Nursing Forms

Personal Care Assistance

Medical Eligibility Determination (MED) Tool (V 8.0)

Quality of Life Interview 2009 Consent Form

OMS Provider Enrollment Forms

PNMI Transfer Forms

HIV, STD and Viral Hepatitis Program Forms

Environmental Health Forms

Radiation Control Program Forms

Subsurface Waste Water Online Feedback Form

Subsurface Waste Water Plumbing Permit Labels Online Form

Subsurface Wastewater Program Forms

Environmental Health Forms

Camp Operators - Reportable/Notifiable Incident Report (HHE-627) (Adobe PDF*)

Suppliers of Compressed Air for Breathing Purposes (Adobe PDF*)

Mental Health Forms

Adult Mental Health Involuntary Commitment Forms

Housing Resources

BRAP (Bridging Rental Assistance Program) (Microsoft Word*)

SPC Shelter Plus Care

PASSR MI Assessment Billing Form (Microsoft Word*)

PASRR - V. Level 1 Screens (Microsoft Word*)

PASRR Level II Assessment Form (Microsoft Word*)

Licensing and Regulatory Forms

Medical Facilities Unit - Incident Report Form for Nursing Facilities (Microsoft Word*)

DLRS Sentinel Event Program Forms

DLRS Mailing List Online Subscription Form

Assisted Housing Program Application for waiver to lower room temperature (Microsoft Word*)

A list of DLRS Forms

Children's Residential Care, Shelters for Children, and Child Placing Agencies - List of Forms

Employee Assistance Programs - Application for Licensure/Certification

Community Service Mental Health - Application for Mental Health Agency License (Microsoft Word*)

Child Care and Nursery school list of Forms

DLRS Application to operate a Licensed Child Care Facility Forms

Miscellaneous Forms

Child Protective Records Research Forms

Maine Cemetery and Crematorium Forms

Bend the Curve

Staff Education and Training Forms

SETU Online Cancellation Form

Request for ID and Password

Post a job

OIAS New Hire Report Form

Contract 2009

Contract 2010

Multicultural Resources Update to Resource Guide Form

*For a free viewer or to request a hard copy

Consumer Forms

Application Forms

Child Care Voucher Application Form

Food Supplement (Food Stamps) - Supplemental Nutrition Assistance Program formerly known as Food Stamps

Application: Non Welfare - Child Support Services

Public Assistance Applications

Licensing and Regulatory Services (DLRS) CNA Application Form

Tattooing, Body Piercing, Electrology, Micropigmentation (Adobe PDF*)

Retail Tobacco (Adobe PDF*)

Eating Places, Lodging Places, Campgrounds, Summer Camps, Schools

Application for Temporary Campground License (HHE-606) (Adobe PDF*)

Bed & Breakfast Requirements (Adobe PDF*)

Eating & Lodging License Application (HHE-602) (Adobe PDF*)

Private Septic System Requirements (HHE-614) (Adobe PDF*)

Private Water Supply Requirements (Adobe PDF*)

Application for Mass Gathering (HHE-607) (Adobe PDF*)

Information/Publications Request Forms

Office of Elder Services publications order form

OSA Library Materials Online Request Form

Online Child Care Information Request Form

Maine Injury Prevention Educational Materials Order Form (Adobe PDF*)

Subsurface Waste Water Online Publications Order Form

Adults with Cognitive & Physical Disabilities Forms

OACPDS Grievance Process Forms

Health Forms

Advance Directives Form

Mental Health Forms

Grievance Process Guide - Level 1 Grievance Reporting Form & Guide (Microsoft Word*)

Riverview Psychiatric Center Pre-Doctoral Internship Evaluation Form

Dorothea Dix Award Nomination Form

Dorothea Dix E-Mail a Patient Greeting Online Form

Licensing and Regulatory Services (DLRS) Community Services Programs Grievance Form

BRAP (Bridging Rental Assistance Program)

Riverview Psychiatric Center Client Grievance Form

SPC (Shelter Plus Care)

Children's Behavioral Health Forms

Children's Behavioral Health Services

Children's Behavioral Health Services - Grievance Policy for Rights of Recipient Form

Contact and Feedback Forms

Subsurface Waste Water Online Feedback Form

Office of Substance Abuse (OSA) Online Ask a Question Form

DHHS Online Contact Forms

Online Adoption Interest Form

DHHS Office of Child and Family Services (OCFS) Online Contact Form

Maine Oral Health Program - Contact Us

Maine Voluntary Response Registry Online Form

Elder Services Online Request to Add a Web Site

Elder Services - Request Information Form

Elder Services Report Abuse Neglect or Exploitation forms

Elder Services - Regrister an Event

Dorothea Dix Online Comment/Question Form

Riverview Psychiatric Center concern/suggection form

Office of Integrated Access & Support (OIAS) Child Support Questions Online Form

Childhood Lead Poisoning Question Form

Infectious Disease Epidemiology Program Comments/Questions

*For a free viewer or to request a hard copy