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Programs & Services for
Info for
Health and Human Services Forms
On this page:
Consumer Forms |
Provider Forms |
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 (Word*)
- Retail Tobacco (Word*)
- Eating Places, Lodging Places, Campgrounds, Summer Camps, Schools
Information/Publications Request Forms
- Aging Services publications order form
- SA 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
Health Forms
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
- Grievance Process Guide for Recipients of Mental Health Services
- 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
- Additional Children's Behavioral Health Services Forms
Contact and Feedback Forms
- Subsurface Waste Water Online Feedback Form
- Substance Abuse (SA) 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
- Aging Services Online Request to Add a Web Site
- Aging Services - Request Information Form
- Aging Services Report Abuse Neglect or Exploitation forms
- Aging Services - Regrister an Event
- Dorothea Dix Online Comment/Question Form
- Office of Family Independence (OFI) Child Support Questions Online Form
- Childhood Lead Poisoning Question Form
- Infectious Disease Epidemiology Program Comments/Questions
Vital Records Forms
- Genealogical Research application (word*)
- Application form (word*)for a search and certified copy of a vital record
- Domestic Partner Registry information, applications
- Marriage Intention form (pdf*)
- Application for Certificate of Marital Status form (word*)
- Chapter 12 Adult Adoptee's Access to Original Birth Certificate (Rules) word*
- Adult Adoptee Access to Application for Adult Adoptee to Original Birth Certificate form word* | pdf*
- Adult Adoptee Access to Medical History form word* | pdf*
- Adult Adoptee Access to Contact Preference form word* | pdf*
- Adoption Reunion Registery Applications for Biological Parents and Other Relatives or Persons Acting on Their Behalf word | pdf*
- Adoption Reunion Registery Applications for Adopted Person or Person Acting on His or Her Behalf word | pdf*
- Adoption Reunion Registery Applications for Person Freed for Adption But not Subsequently Adopted or Person Acting on his or Her Behalf word* | pdf*
Provider Forms
Substance Abuse Forms
- SA Forms
- SA DEEP Forms
- SA Treatment Forms
- SA Provider Prevention Forms
- SA Treatment Data Systems Forms
- SA Fiscal and Contract Forms
- SA Safe and Drug Free Schools and Communities
- Alcohol and Drug Treatment Program Application (word*)- Application for Licensure and Certification of Substance Abuse Treatment Program
Adults with Disabilities Forms
- Developmental Services Case Management Forms
- Application for Certification as Provider of Section 13.05, Targareted Case Management Services
- PCP Forms
- Provider Resource Directory Information Forms
- Behavioral Regulations/Three Person Committee Forms
- Support waiver
Children's Behavioral Health 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
- Newborn Bloodspot Screening Report of Repeat Specimens Submitted (pdf*)
- Newborn Bloodspot Screening Test Refusal Form (pdf*)
- Disease Reporting
- Maine Occupational Disease Reporting Form (pdf*)
- Infectious Disease Epidemiology Program - Request for Data
- Maine Breast and Cervical Health Program Forms
- Maine Immunization Program Forms
- MaineCare Home Health Forms
- Aging Services Online Request to Add a Web Site
- Nursing Facilities Provider Forms
- Personal Care Assistance
- Medical Eligibility Determination (MED) Tool (V 8.0)
- PNMI Transfer Forms
- HIV, STD and Viral Hepatitis Program Forms
Environmental Health Forms
- Radiation Control Program Forms
- Subsurface Waste Water Online Feedback 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
- Case Management Treatment Plan Review Directions (Microsoft Word, Adobe PDF*)
- Case Management Treatment Plan Review Form (Microsoft Word, Adobe PDF*)
- Critical Incident Form (Microsoft Word, Adobe PDF*)
- Critical Incident Form Directions (Microsoft Word, Adobe PDF*)
- Housing Resources
- PASSR MI Assessment Billing Form (Microsoft Word*)
- PASRR - V. Level 1 Screens (Microsoft Word*)
- PASRR Level II Assessment Form (Microsoft Word*)
- Request to Terminate or Interrupt Services Form (Microsoft Word, Adobe PDF*)
- Service Agreement Form (Microsoft Word, Adobe PDF*)
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
- OFI New Hire Report Form
- Contracts
- Multicultural Resources Update to Resource Guide Form
