Important Updates:
The KDADS website has a new look but the same information you rely on. This is the NEW official KDADS website.
Department for Aging and Disability Services
Home MenuDocuments & Forms
KDADS General Forms
KDHE Policy Forms
Forms are sorted by those that are strictly for internal purposes and communication and those that are sent outside of the agency. Forms have retained their original form number where applicable.
Notification of KanCare HCBS Services
Notification of KanCare, HCBS Changes and Updates
ADRC Provider Forms
ADRC Information Referral Assistance Fillable
ADRC Information, Referral and Assistance Form- ADRC Options Counseling Fillable
ADRC Provisional Plan Of Care- FAI Complete 01.02.2013 - PDF
- FAI Complete Fillable 01.02.2013 - WORD
- FAI LOC Outcome - English
- FAI LOC Outcome - Spanish
- HCBS BI Attestation Form
- PD ACE Form
- PD Applicant Crisis Evaluation (PD-ACE) Form ES
- PD Crisis Exception Physician Statement
- PD Crisis Exception Physician Statement Form ES
Behavioral Health Services Forms
CARE Forms
Extraordinary Funding Forms
Quarterly Reports
IDD Assessor Forms
- BASIS Assessment 12.2013
- BASIS Assessment Section for Screeners Clarifications
- BASIS Manual V 60
- BASIS Medical Conditions Def
- Childrens Assessment
- General Guidelines for BASIS Assessors
- I/DD Medicaid Waiver Individual Choice
- IDD Notification and Provisional Plan of Care Form
- Statewide BASIS Roundtable Meeting Minutes
- 2014.02.03 Auth Day Supports Weather
- Case Manager Rules of Conduct
- Case Manager Rules of Conduct
Complaint Tracking Form- I/DD System Capacity Report Template
- IDD Provider Billing Guidelines AMG
- IDD Provider Billing Guidelines United
- Workflow Corrective Action
- Workflow IDD Initial Access 01 16 14
- Workflow New Provider Affiliation
- Workflow Quality Assurance Data Collection
IDD TCM Documents
Older Americans Act / Senior Care Act
- 11.22.22-Revised Template-OAA-MASTER-FFY2023-Budget
- 2024 Spanish-Uniform-Program-Registration
- 2024 Spanish-Uniform-Program-Registration - WORD
- 2024 Uniform Program Registration
- 2024 Uniform Program Registration Pg 1 Only
2024 Uniform Program Registration Pg 1 Only WORD- 2024 Uniform Program Registration -WORD
- 3.18.22 Revised Arpa BUDGET template
- 3.18.22 Revised_OAA-COVID19-Consolidated-Financial-Reports
- Abbreviated-Uniform-Assessment-Instrument-Effective-10.01.21
- AP Program Characteristics (Meal Outputs) -Nutrition for FFY2024
- ARPA Individual Financials for PSAs 07.21.23
- Authorization for Release of Protected Health Information
- Case Management
- Consumer Rights and Responsibilities SS-012
- Customer Code of Conduct SS-043 - PDF
- Customer Code of Conduct SS-043 - Word
- Customer Fee Agreement SS-011
- Customer Service Worksheet - PDF
- Customer Service Worksheet - Word
PACE Forms
SED Forms
- Attachment A Initial Clinical Eligibility Form
- Attachment B Request for Exception to Minimum Age Criteria
- Attachment C Initial Request For Exception to Age 18 Criteria
- Attachment D Request for Exception to CBCL Criteria
- Attachment E SED Waiver Annual Evaluation of Level of Care (LOC)
- HCBS SED Participant Interest Inventory
- SED Eligibility New Process
- SED Provisional Plan of Care