Search. Mail a completed copy to the Division of Vital Records. To sign up for updates or to access your subscriber preferences, please enter your contact information below. Continuity of Care Form. All downloads are in Adobe Acrobat PDF format unless otherwise specified. By Program If the file doesn’t open, right click on the link for the … Documents on the HHS Web sites are available in PDF format. Forms HHS forms are used every day to perform tasks such as applying for benefits, contracting to provide goods or services, reporting incidents, declaring end … Local Health Department Paternity Affidavit – Child More than 60 Days Old ; Local Health Department Paternity Affidavit – Child Less than 60 Days Old COVID-19 Complaint Form; PA DOH Guidance, Fact Sheets and Resources. U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Office of Environmental Health Services Bedding and Upholstery Inspection. Denial of Access to Patient Information and Appeal Form, NY Appendix A: MDS 3.0 NY–Specific Requirements, NY Appendix B: jRAVEN Configuration Instructions for NY, Nursing Home Administrator Licensure Application and Continuing Education Reporting Forms, Nursing Home Nurse Aide Application and Forms, New York State Donate Life Registry Enrollment Form, New York State Donate Life Registry Specification Form, Hospital and Community Patient Review Instrument (H/C–PRI), Hospital and Community Patient Review Instrument Instructions, Emergency Pesticide Application Notification Exemption Reporting Form, Forms from the Office of the Professions, NYS Education Department, File a Complaint about a Physician or a Physician Assistant, Drinking Water State Revolving Fund (DWSRF), Application of Radiologic Technologist Licensure, DAL 09–08 – Revised SCREEN Form Implementation, Revised Page 4 of Instruction Manual for SCREEN Form DOH–695 (02/2009), Instruction Manual for SCREEN Form DOH–695 (02/2009), SCREEN/PASRR Frequently Asked Questions (FAQ), Engineering Report for Swimming Pool Plans, Engineering Report Form for Bathing Beaches, Swimming Pool & Bathing Beach Safety Plan Checklist, Written Notification for Supervision of Bathing Facilties at Temporary Residences & Campgrounds, Temporary Assistance, Medical Assistance, Food Stamp Benefits, and Services including Foster Care and Child Care Assistance, Clinical Laboratory Evaluation Program (CLEP), Blood and Tissue Resources Program (BTRP), Environmental Laboratory Approval Program (ELAP), Addressing the Opioid Epidemic in New York State, Learn About the Dangers of "Synthetic Marijuana", Help Increasing the Text Size in Your Web Browser, Prevent Herpes Transmission During Ritual Circumcision, Effective for assessments beginning 10/01/2019, Effective for assessments in the period: 10/1/2017 – 9/30/18, Effective for assessments in the period: 4/1/2011 – 9/30/17, Section Z: Assessment Administration (New York, CMS MDS 3.0 resources (scroll to the Download section of each page). Communications Officer. Washington, D.C. 20201 Toll Free Call Center: 1-877-696-6775 Home > Find forms to File a Complaint online for health care professionals, a facility, medical marijuana consultants, etc., or reach someone by phone at 360-236-4700. Forms. We are committed to ensuring that all HHS forms on this Web site are fully accessible to individuals with disabilities in accordance with Section 508 of the Rehabilitation Act.If you have any difficulty viewing any page with adaptive technology, please contact the webmaster for this site, or the HHS Forms Coordinator.. If an “Enter Network Password” pop-up window appears when downloading a file, click the cancel button and the file should open. An A to Z list of forms located on the Australian Government Department of Health website. Page last updated: 11 December 2015 Further information on health issues and publications are available on healthdirect , the Department's A-Z Index and A-Z Publications pages. The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Divisions of HHS commonly use websites, blog entries, and social media posts to issue communications with regulated parties. 2021 State of the State Address: Governor Ned Lamont delivered the 2021 State of the State address on Wednesday, January 6 at noon.Watch it here. Paternity Affidavit - Hospital Use (State Form 44780) July 1, 2010 and after - Local Health Department Paternity Affidavit Form - to be completed by the Local Health Department only. Toll Free Call Center: 1-877-696-6775, Content created by Program Support Center (PSC). Quick Links Vital Records 331-154 (cream) - Cross-Connection Control Program Summary Report for 2015 (Word) (PDF) 331-155 (blue) - Public Water System Cross-Connection Control Activities Annual Summary Report for 2015 (Word) (PDF) 331-156 (green) - Exceptions to High-Health Hazard Premises Isolation Requirements for 2015 Annual Summary Report (Word) (PDF) 331-434 (gray) - Cross-Connection Control Severe Health Hazard Facility Report for 2015 (Word) (PDF) 331-457 - Backflow Incident Report (Word) (PDF) 331-47… Health Care Proxy Form Order Form; Health Care Proxy Form; Health Care Reform Act (HCRA) HCRA Forms; Health Facilities Cash Assessment Program (HFCAP) Quarantine-Isolation Work Guidance (PDF); Case, Contact, and Contact of a Contact Infographic Get the facts at ct.gov/coronavirus. The Louisiana Department of Health protects and promotes health and ensures access to medical, preventive and rehabilitative services for all citizens of the State of Louisiana. Popular searches. Inform public health response to prevent further spread of SARS-CoV-2; Here are two additional resources to help reporting jurisdiction health departments complete the case report form: COVID-19 Case Report Form Instructions pdf icon; Data Dictionary pdf icon; Please note that the form, instructions, and data dictionary were updated on May 5, 2020. Browsers that can not handle javascript will not be able to access some features of this site. HHS Forms, Health and Human Services FormsPublic Use Forms by Number Public Use Forms by Title, Other HHS Forms SitesAdministration for Children and Families (ACF)Center for Medicare and Medicaid Services (CMS)Food and Drug Administration (FDA)National Institutes of Health (NIH). Virginia Beach Department of Public Health: Special Event Guidelines and Requirements Brochure Virginia Beach Department of Public Health: Special Event Application Summer Camp Program: This site provides travel guidelines, Traveler Health Form, and pertinent information for all travelers to and within Hawaiʻi. As of January 2019, the following three updated forms are available for use. Forms for Health Care Providers Information for Health Care Providers; Day Care Centers/Homes Certificate of Authority Form (PDF) Return to beginning of index. The forms are listed alphabetically by form number in PDF … While these communications may provide the public with helpful information they cannot, by themselves, impose binding new obligations on regulated entities. 200 Independence Avenue, S.W. December 10, 2020: New York State Department of Health Announces Today Is "Get Covered Day" in New York State November 30, 2020: Media Advisory - New York State Drinking Water Quality Council to Meet on December 8, 2020 COVID-19 Information for Businesses Public Health Complaints and Concerns. Search. Additionally, the Department focuses on preventing disease and promoting wellness and health equity for all people. Daniel W. Gilmore, PhD, MPH Director of Health Patrice A. Bogan, MS, FNP Deputy Director of Health: Oneida County Department of Health Adirondack Bank Building The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Official website for State of Hawaiʻi Department of Health, Disease Outbreak Control Division (DOCD) travel information. Adoptee's Application for Noncertified Copy of Original Birth Record; Application for a Birth Certificate; Application for a Birth Certificate with Fees Waived for an Individual Who is … Bedding & Upholstered Furniture Forms; Division of Food and General Environmental Services Search this site. HHS Headquarters. 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