The Safety and Quality Enhancement Dollars Form is available to reimburse license exempt providers for purchases made to meet DHS Health and Safety Requirements. Providers can be reimbursed up to $250 per year according to our Collective Bargaining Agreement.

Forms can be downloaded at the links below:

• Safety and Quality Enhancement Dollars Form – Russian.pdf
• Safety and Quality Enhancement Dollars Form – English.pdf
• Safety and Quality Enhancement Dollars Form – Chinese.pdf
• Safety and Quality Enhancement Dollars Form – Vietnamese.pdf
• Safety and Quality Enhancement Dollars Form – Spanish.pdf