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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.. An A to Z list of forms located on the Australian Government Department of Health website. NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE BUREAU OF CHILD CARE STAFF HEALTH FORM Initial employment and every 2 years, a health examination is required for all teaching and non-teaching staff members, including volunteers and students who regularly associate with children. Health Care Proxy. Washington, D.C. 20201 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. 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. Office of Environmental Health Services Bedding and Upholstery Inspection. COVID-19 Information for Businesses Public Health Complaints and Concerns. Mail a completed copy to the Division of Vital Records. 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 … The Michigan Department of Health and Human Services (MDHHS) - A library of Michigan Department of Community Health forms used by health care providers. Browsers that can not handle javascript will not be able to access some features of this site. U.S. Department of Health & Human Services 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… Forms used when applying for construction or repair of an onsite sewage treatment and disposal system (OSTDS). Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, New York State Condom Program Organization Information and Attestation (OIA) Form, Uninsured Care Programs Provider/Service Manuals, Uninsured Care Programs Assurances & Agreements with Enrollment Form, HIV Uninsured Care Programs Application (English), Solicitude para el Programa de Cuidado de VIH (Español), Home Health Certification and Plan of Treatment, Home Care DME Prior Aproval Request AI–3615, Required HIV Related Consent & Authorization Forms, Expanded Syringe Access Program (ESAP) Forms, HIV/AIDS Educational Materials Order Forms, Americans with Disabilities Act Complaint Form, Application for Asbestos Training Equivalency (DOH–4353), Application for Approval or Revision of an Asbestos Safety Training Program, User ID Application for Electronic Filing, Applications and Forms for Participating Day Care Centers, Applications and Forms for Participating Day Care Homes, Children's Camp Facility & Staff Description, Children's Camp Additional Staff Qualifications, Prospective Children' Camp Director Certified Statement, Request for Prior Approval of Orthodontic and Orthdontia–Related Services, Nonhospital DNR and Do Not Intubate (DNI) Order, Early Intervention Publications Order Form, Forms Commonly Used by EMS Providers and Agencies, Elderly Pharmaceutical Insurance Coverage (EPIC), Health Insurance and Nutrition Application for Children, Adults, and Families, Women, Infants and Children (WIC) Nutritional Program, Home Care Agencies (CHHA, LTHHCP and PCP), TLC Learning Center Application/Wait List Form, Opioid Overdose Prevention Program Registration, Criminal History Record Check Request Form, Lead Poisoning Prevention Education Materials. 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