Frequently used forms and resources

This page lists DHS forms, briefcase resource documents and additional resources referenced throughout the DD Screening Document Codebook. Use the DHS eDocs searchable document library to search for and download forms, applications and other documents in other languages.

Forms

Case Manager’s Guide to Determining ICF/DD Level of Care, DHS-4147A (PDF)
DD Screening Document, DHS-3067 (PDF)
Nursing Facility Level of Care – Preadmission Screening and Community Assessment for People Younger than 21 Years Old, DHS-3361 (PDF)
OBRA Level I Criteria – Screening for Developmental Disabilities or Mental Illness, DHS-3426 (PDF)
OBRA Level II evaluative report for people with developmental disabilities, DHS-4248 (PDF)
OBRA Level II evaluative report signature sheet, DHS-4248B (PDF)
Related Conditions Checklist/Instructions, DHS-3848 (PDF) and Instructions, DHS-3848 (PDF)

Refer to CBSM – Forms for additional forms.

Briefcase resource documents

Challenging behavior definitions (PDF)
Challenging behavior rating scale (PDF)
Checklist for completing the DD screening document (PDF)
Current and planned services definitions (PDF)
DD screening document edits (PDF)
DT&H staffing ratios (PDF)
Independent living skills definitions (PDF)
Minnesota county codes (CBSM page)
Special support services definitions (PDF)