Care Coordinator Manual and Forms
- Alaska Medicaid — TEFRA Checklist
- Authorization for Release of Information Form
- Care Coordinator Manual
- Estimated Medical Expenses (COC) Form
- IDD-03 ICAP Assessment Information and Consent Form
- Inpatient Psychiatric Hospital (LOC) Form
- Med 1 — Child's Medical History and Disability Report
- Med 2 — Release of Information
- Med 4 — Application for Adults and Children With Long-Term Care Needs
- Med 15 — Alaska Medicaid — TEFRA Brochure
- Med 24 — Nursing Facility Level of Care (LOC) Form
- Med 36 — TEFRA Initial Application Extension Request Form
- Modified Adjusted Gross Income (MAGI)
- Plan of Care (POC) Form
- Qualifying Diagnosis Certification
- SDS Approved Forms
- SDS Regulations
- Social Security Disability Listings
- 24-Hour Parent Log — Includes instructions, examples and blank form
Education and Training
Division of Public Assistance Care Coordinator Training-August 25, 2021 (recording)
If you’d like a copy of the PPT presentation, please call Comagine Health at 907-550-7600, option 3, or toll-free at 888-578-2547, option 3.