DHS-7109 form guide
How to complete DHS-7109 for an EIDBI treatment plan
A plain-language guide to Minnesota's EIDBI Individual Treatment Plan and Progress Monitoring form, including the 2026 version requirement and six-month review workflow.
This guide does not replace DHS policy, payer requirements, legal advice or professional judgment. Never change, omit or invent diagnoses, symptoms, service times, signatures, evaluations or household information to obtain eligibility or payment. Report corrections through the responsible provider, health plan, county, Tribal Nation or DHS.
What DHS-7109 is for
DHS-7109 is the person-centered plan of care for someone who meets EIDBI medical-necessity criteria. The QSP uses it to document the initial ITP and progress-monitoring updates, incorporating information from the person's CMDE.
Use the current form version
DHS says providers must use the most current DHS-7109 for new recipients and required six-month progress updates. Effective September 1, 2026, DHS will not accept versions older than February 2026.
- Download a fresh copy from DHS rather than reusing an old local template.
- Complete every required field.
- Enter “N/A” where a field does not apply instead of leaving it blank.
Write measurable, person-centered goals
The plan should connect assessed need, the person's and family's priorities, intervention, measurement and expected functional outcome. Progress data should allow the team to determine whether a goal is new, changed, continued, discontinued or mastered, with the reason or data supporting that status.
Monitor progress throughout treatment
DHS expects frequent, systematic data review rather than waiting for the formal update. The QSP should use real-time treatment data to identify trends and make timely changes. The formal progress update is submitted after each six months of treatment or more frequently when the CMDE provider or QSP determines it is needed.
Update the plan when needs change
When data shows that goals are mastered or treatment needs adjustment, the QSP and qualified team should update the ITP and review it with the caregiver or guardian. Changes to approved frequency, intensity or duration require the appropriate authorization process.
Common questions
Frequently asked questions
How often is DHS-7109 progress monitoring submitted?
DHS says after each six months of treatment, or more frequently as determined by the CMDE provider or QSP.
Can a provider leave an inapplicable field blank?
No. Current DHS guidance says to use “N/A” when a field is not applicable and not to leave fields blank.
Can an older DHS-7109 still be used?
DHS states that effective September 1, 2026, it will not accept forms older than the February 2026 version.
From guidance to daily work
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