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
- Medical Assistance Program Prior Authorization Request (PAR) Form
- Release of Information Form
Links to Additional Forms