POA
Anchorage Accessible Housing List
Elder Services, Inc.
Anchorage Senior Living, Inc.
Jewel Lake Senior Housing, Inc.
Senior Housing Alternatives, Inc.
Sullivan Senior Housing Inc.
Independence Park Senior Housing Inc. I & II
Senior Housing Eligibility
Incontinence CMN
Assessment Letter
Emergency Response Plan
New Client Checklist
used to provide assessors information if unable to attend the assessment

Medical 
Waiver Program Handout
Lifeline Sample Letter
Sample 
Letters & Forms

Housing
Common 
Forms & Handouts
ANHC Blank ROI
Contract
Nursing Facility 
Transition Program
Application
CMS Power WC guidelines
Cost of Care Brochure
Miller Trust Application
through Alaska Legal Services
Estate Recovery Brochure

DPA

 Miscellaneous
Elder Law Attorneys 2021
SDS Waiver Brochure
Miller Trust Brochure
Comfort One Brochure
(Does not include Health Care)
Advanced Health Care Directive
Medicaid Standards 2022
ADRC Brochure
Alaska Legal Services Application
AMHTA/Alzheimer's Resource Mini-Grant
DMV Application for Disabled Parking ID
Medicare Power Chair Requirements
Acuity Add On Checklist
DPA Emails and Fax Numbers
CSFP Application

RL Chair Sample Letter
Blank CAT
Anchorage application - 
Refer to thier website for other locations
Verification of Diagnosis Form (VoD)
Disaster Preparedness Toolkit
Medicaid Recipient Handbook
Waiver Renewal Checklist
Provider Specific ICD10 Codes
Earthquake Emergency Information
DP Toolkit for Children with Special Needs
DME List
Reapplication Checklist
Heath Care Directive Resources
DD Vision Development Report
DD Vision Handout
PLEASE NOTE:
Some of the listed forms are for 
reference or informational 
purposes only. 
In some cases, there may be more current specific forms available.  
If you discover a form that needs to be updated, removed, 
or added,
please email 
alaskaccn@gmail.com 
so we can make any necessary changes.
Thank you!
Acronyms
**Please click the link button for DPA forms and search for the form you need**



COMMON DPA FORMS
Application for Services GEN 50C
Denial of Assets Transfer MED 03
LTC Medicaid Application MED 04
Heating Assistance Application HAP 01
Eligibility Review Form GEN 72
Burial Assistance Application GEN 60