California Department of Public Health Forms

This form is used for testing and reporting cases of Zika virus in Los Angeles County, California. It allows individuals to provide necessary information to health authorities for monitoring and controlling the spread of Zika virus.

This form is used for requesting an unrestricted certified copy of a birth record in California.

This document is used to apply for a certified copy of a birth or death record in the state of California.

This document is used to request a certified copy of a birth record from the County of Santa Barbara, California.

This form is used for requesting a certified copy of a birth record from Mendocino County, California.

This document is a template for a sworn statement, commonly used in California. It is used to provide a written and signed statement of facts or information under penalty of perjury.

This form is used for reporting cases of measles (rubeola) in the state of California.

This document is used to apply for a certified copy of a birth record in San Bernardino County, California.

This form is used for requesting a certified copy of a birth record in Sonoma County, California.

This document is a pediatric tuberculosis (TB) risk assessment questionnaire for residents of Los Angeles County, California. It is used to evaluate the likelihood of TB infection in children.

This document is used to apply for a birth record in Norwalk, California.

This document is a template for a completion certificate for the Child Health and Disability Prevention (CHDP) Program in California. It is used to acknowledge the successful completion of the program by participants.

This Form is used for reporting adult HIV/AIDS cases in California.

This form is used for reporting animal rabies cases in California. It helps track and document data related to rabies cases in animals.

This document provides a fact sheet about diabetes in the state of California. It includes information and statistics on the prevalence, risk factors, and impact of diabetes in California.

This form is used for requesting a confidential marriage license in California. It also includes an affidavit of inability to appear, which is required in certain cases.

This document is for obtaining a certified copy of a birth certificate in California. It is used to prove one's identity and date of birth.

This form is used for submitting a reference examination for influenza in the state of California. It is important for tracking and monitoring influenza cases.

This document is a self-inspection checklist for swimming pools and spas in Kern County, California. It helps ensure that these facilities are in compliance with safety regulations.

This form is used for applying for a birth certificate from the City of Pasadena, California.

This form is used for reporting and verification of tuberculosis cases in California. It is a mandatory document to ensure accurate and timely reporting of tuberculosis cases in the state.

This form is used for reporting the initial drug susceptibility of a verified case of tuberculosis. It is a follow-up report specific to California.

This form is used for reporting and documenting the completion of tuberculosis cases in California. It is required for follow-up reporting and provides important information about the patient's treatment and progress.

This form is used for the surveillance of Hansen's Disease (Leprosy) in California.

This form is used for reporting confidential health information of animal patients in California. It ensures the confidentiality of the information provided.

This form is used for recording Nuchal Translucency (NT) exam data as part of the California Prenatal Screening Program in California.

This form is used for analyzing client accommodations in California. It is a document that helps assess the needs and requirements of clients for various accommodations.

This form is used for authorized users of radioactive materials in California to document their training and experience, as well as obtain attestation from their preceptor.

This document is used for completing the necessary requirements to take the REHS Exam in California. It provides information on the qualifications and steps needed to be eligible for the exam.

This form is used for ensuring that consulting physicians in California comply with regulatory requirements.

This form is used for follow-up appointments with a physician in California. It helps track and assess the progress of a patient's medical treatment.

This Form is used for collecting data on food availability and marketing at reasonable prices in California.

This form is used in California to gather information about alternate qualifications for a worksite.

This Form is used for qualifying worksites in California. It is used to determine if a worksite meets the necessary requirements and standards set by the state.

This document is a checklist for the Childhood Lead Poisoning Prevention Program in California, available in both English and Spanish. It helps ensure that all necessary steps are taken to prevent lead poisoning in children.