Section 1 of 1 in this document
Division of Long Term Service and Supports (LTSS) Brochure Order Form
What organization are you ordering materials for?
Full Name
First Name
Last Name
Email
Where should we send the brochures?
Street Address
City
State
Zip
Are you a First Responder
Yes
No
Which First Responder materials would you like to order?
DHS Adult Protective Servcies Booklet (Available to First Responders Only)
DHS Adult Protective Services Business Card (Available to First Responders Only)
How many DHS Adult Protective Services Booklets are you requesting?
25
50
75
100
200
How many DHS Adult Protective Business Cards are you requesting?
25
50
75
100
200
Which materials would you like to order?
DHS Division of Long Term Services and Supports Overview Booklet
Connection to Support When You Need It Rack Card (Dakota at Home and Long Term Services and Supports)
Long Term Services and Supports Path to Services Flow Chart
Ombudsman Rack Card- #7000
Ombudsman Poster - #7001 Residents’ Rights
Ombudsman Poster - #7002 Ombudsman for Quality of Life
Ombudsman Poster - #7003 Ombudsman for Residents’ Rights
Ombudsman Poster - #7004 Ombudsman for Person-Centered Care
Ombudsman Booklet- #7005 Residents’ Rights in Assisted Living
Ombudsman Booklet- #7006 Residents’ Rights in Nursing Home
Caregiver Guide to Navigating Dementia
How to Recognize & Report Elder Abuse
How many DHS LTSS Overview Booklets are you requesting?
25
50
75
100
200
How many Connection to Support When you Need It Rack Cards (Dakota at Home and LTSS) are you requesting?
25
50
75
100
200
How many LTSS Path to Servcies Flow Charts are you requesting?
25
50
75
100
200
How many Ombudsman RACK Cards (#7000) are you requesting?
25
50
75
100
200
How many Dakota at Home Ombudsman Posters- Residents' Rights (#7001) are you requesting?
25
50
75
100
200
How many Ombudsman Posters -Ombudsman for Quality of Life (#7002) are you requesting?
25
50
75
100
200
How many Ombudsman Posters -Ombudsman for Residents' Rights (#7003) are you requesting?
25
50
75
100
200
How many Ombudsman Posters -Ombudsman for Person Centered Care (#7004) are you requesting?
25
50
75
100
200
How many Ombudsman Posters -Residents' Rights at Assisted Living (#7005) are you requesting?
25
50
75
100
200
How many Ombudsman Posters -Residents' Rights at Nursing Home (#7006) are you requesting?
25
50
75
100
200
How many Caregiver Guides to Navigating Dementia are you Requesting?
25
50
75
100
200
How many How to Recognize & Report Elder Abuse are you requesting?
25
50
75
100
200
disregard this