These resources are for information purpose only. The current form may have been updated. Please visit their respective website for any updates.

Department of Human Services Benefit Application

http://www.dhs.pa.gov/applyforbenefits/index.htm

Physician Certification Form

https://paieb.com/doc/Physicians_Certification_Form.pdf

Steps to Apply For Medical Waiver

https://paieb.com/doc/StepsToApply.pdf

Referral Form

https://paieb.com/doc/Web_Referral_Form.pdf