Forms

The first two forms on this page are necessary for hospitals, nursing homes and community centers to refer individuals for long term care services.

Nursing Homes and Hospitals should use fax numbers: 720.974.2432 | 720.974.2433 Main Fax: 720.974.0053 | Intake Fax Number: 720.974.0054

Downloadable Word Documents

* PC Users: Right-Click to Download and Save Editable Forms

Intake Screening Form
Professional Medical Information Page (PMIP) Form
Longterm Home Health Prior Authorization Request (PAR) Form
Release of Information Form

Links to Additional Forms

SEP Forms
Medicaid Application