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299
![OCA Official Form 960 "Authorization to Release Health Information Pursuant to Hipaa" - New York](https://data.templateroller.com/pdf_docs_html/103/1031/103199/oca-official-form-960-authorization-to-release-health-information-pursuant-to-hipaa-new-york.png "OCA Official Form 960 "Authorization to Release Health Information Pursuant to Hipaa" - New York")
OCA Official Form 960 "Authorization to Release Health Information Pursuant to Hipaa" - New York
Size: 62 KB
2 pages
This is a legal document signed by a patient that gives consent to the release of health information within the state of New York.
![Form DOH-4444 "Self-declaration of Income" - New York](https://data.templateroller.com/pdf_docs_html/345/3453/345344/form-doh-4444-self-declaration-income-new-york.png "Form DOH-4444 "Self-declaration of Income" - New York")
Form DOH-4444 "Self-declaration of Income" - New York
Size: 20 KB
1 page
This is one of the documents you need to fill out when applying for Public Health Insurance Programs in the state of New York.
![Form DOH-44 "Application for a Permit for a Public Gathering" - New York](https://data.templateroller.com/pdf_docs_html/1879/18791/1879148/form-doh-44-application-for-a-permit-for-a-public-gathering-new-york.png "Form DOH-44 "Application for a Permit for a Public Gathering" - New York")
![Form DOH-30 "Adoptee Registration Form" - New York](https://data.templateroller.com/pdf_docs_html/1867/18674/1867420/form-doh-30-adoptee-registration-form-new-york.png "Form DOH-30 "Adoptee Registration Form" - New York")
![Form DOH-80 "Notice of Course Cancellation" - New York](https://data.templateroller.com/pdf_docs_html/1865/18658/1865858/form-doh-80-notice-of-course-cancellation-new-york.png "Form DOH-80 "Notice of Course Cancellation" - New York")
![Form DOH-89 "Certified Class List for Ancillary EMS Training Courses" - New York](https://data.templateroller.com/pdf_docs_html/1879/18791/1879122/form-doh-89-certified-class-list-for-ancillary-ems-training-courses-new-york.png "Form DOH-89 "Certified Class List for Ancillary EMS Training Courses" - New York")
![Form DOH-65 "Application for Emergency Medical Services Certification" - New York](https://data.templateroller.com/pdf_docs_html/1879/18791/1879133/form-doh-65-application-for-emergency-medical-services-certification-new-york.png "Form DOH-65 "Application for Emergency Medical Services Certification" - New York")
![Form DOH-79 "Students Ineligible to Take the State Certifying Examination" - New York](https://data.templateroller.com/pdf_docs_html/1879/18791/1879131/form-doh-79-students-ineligible-to-take-the-state-certifying-examination-new-york.png "Form DOH-79 "Students Ineligible to Take the State Certifying Examination" - New York")
![Form DOH-372 "Application for Radiologic Technologist Licensure" - New York](https://data.templateroller.com/pdf_docs_html/2033/20330/2033001/form-doh-372-application-for-radiologic-technologist-licensure-new-york.png "Form DOH-372 "Application for Radiologic Technologist Licensure" - New York")
![Form DOH-348 "Application for Approval of Plans for Public Water Supply Improvement" - New York](https://data.templateroller.com/pdf_docs_html/1879/18792/1879216/form-doh-348-application-for-approval-of-plans-for-public-water-supply-improvement-new-york.png "Form DOH-348 "Application for Approval of Plans for Public Water Supply Improvement" - New York")
![Form DOH-799 "Wic Medical Referral Form" - New York](https://data.templateroller.com/pdf_docs_html/1729/17292/1729229/form-doh-799-wic-medical-referral-form-new-york.png "Form DOH-799 "Wic Medical Referral Form" - New York")
![Form DOH-352 "Application for Renewal of Certification Water System Operator" - New York](https://data.templateroller.com/pdf_docs_html/1879/18792/1879211/form-doh-352-application-for-renewal-of-certification-water-system-operator-new-york.png "Form DOH-352 "Application for Renewal of Certification Water System Operator" - New York")
![Form DOH-206 "Application for EMS Operating Certificate" - New York](https://data.templateroller.com/pdf_docs_html/1879/18791/1879104/form-doh-206-application-for-ems-operating-certificate-new-york.png "Form DOH-206 "Application for EMS Operating Certificate" - New York")
![Form DOH-367 "Children's Camp Facility and Staff Description" - New York](https://data.templateroller.com/pdf_docs_html/1879/18790/1879074/form-doh-367-children-s-camp-facility-and-staff-description-new-york.png "Form DOH-367 "Children's Camp Facility and Staff Description" - New York")
![Form DOH-350 "Application for Certificate of Waiver From Disinfection Requirements" - New York](https://data.templateroller.com/pdf_docs_html/1879/18792/1879217/form-doh-350-application-for-certificate-of-waiver-from-disinfection-requirements-new-york.png "Form DOH-350 "Application for Certificate of Waiver From Disinfection Requirements" - New York")
![Form DOH-389 "Confidential Case Report" - New York](https://data.templateroller.com/pdf_docs_html/1867/18673/1867354/form-doh-389-confidential-case-report-new-york.png "Form DOH-389 "Confidential Case Report" - New York")
![Form DOH-359 "Annual Report on Violations of Watershed Rules and Regulations" - New York](https://data.templateroller.com/pdf_docs_html/1879/18792/1879225/form-doh-359-annual-report-on-violations-of-watershed-rules-and-regulations-new-york.png "Form DOH-359 "Annual Report on Violations of Watershed Rules and Regulations" - New York")
![Form DOH-166 "Controlled Substance Inventory Form" - New York](https://data.templateroller.com/pdf_docs_html/2011/20113/2011389/form-doh-166-controlled-substance-inventory-form-new-york.png "Form DOH-166 "Controlled Substance Inventory Form" - New York")
![Form DOH-695 "Screen Form" - New York](https://data.templateroller.com/pdf_docs_html/1864/18642/1864290/form-doh-695-screen-form-new-york.png "Form DOH-695 "Screen Form" - New York")
![Form DOH-132 "Wic Medical Referral Form for Infants and Children" - New York](https://data.templateroller.com/pdf_docs_html/328/3289/328986/form-doh-132-wic-medical-referral-form-infants-and-children-new-york.png "Form DOH-132 "Wic Medical Referral Form for Infants and Children" - New York")
![Form DOH-349 "Application for Certificate of Approval for Bottled or Bulk Water Facilities" - New York](https://data.templateroller.com/pdf_docs_html/1879/18792/1879215/form-doh-349-application-for-certificate-of-approval-for-bottled-or-bulk-water-facilities-new-york.png "Form DOH-349 "Application for Certificate of Approval for Bottled or Bulk Water Facilities" - New York")
![Form DOH-694 "Hospital and Community Patient Review Instrument (Hc-Pri)" - New York](https://data.templateroller.com/pdf_docs_html/1864/18642/1864289/form-doh-694-hospital-and-community-patient-review-instrument-hc-pri-new-york.png "Form DOH-694 "Hospital and Community Patient Review Instrument (Hc-Pri)" - New York")
![Form DOH-360 "Water Systems Operation Report - Microbiological Sample Results" - New York](https://data.templateroller.com/pdf_docs_html/1879/18792/1879231/form-doh-360-water-systems-operation-report-microbiological-sample-results-new-york.png "Form DOH-360 "Water Systems Operation Report - Microbiological Sample Results" - New York")
![Form DOH-485 "Workers' Compensation Preferred Provider Organization (Ppo) Application" - New York](https://data.templateroller.com/pdf_docs_html/1879/18792/1879201/form-doh-485-workers-compensation-preferred-provider-organization-ppo-application-new-york.png "Form DOH-485 "Workers' Compensation Preferred Provider Organization (Ppo) Application" - New York")
![Form DOH-794 "Regulatory Compliance Statement" - New York](https://data.templateroller.com/pdf_docs_html/1879/18791/1879199/form-doh-794-regulatory-compliance-statement-new-york.png "Form DOH-794 "Regulatory Compliance Statement" - New York")
![Form DOH-347 "Application for Approval of Backflow Prevention Devices" - New York](https://data.templateroller.com/pdf_docs_html/1879/18792/1879213/form-doh-347-application-for-approval-of-backflow-prevention-devices-new-york.png "Form DOH-347 "Application for Approval of Backflow Prevention Devices" - New York")
![Instructions for Form DOH-743 "Instructor Information Sheet" - New York](https://data.templateroller.com/pdf_docs_html/570/5704/570464/instructions-for-form-doh-743-instructor-information-sheet-new-york.png "Instructions for Form DOH-743 "Instructor Information Sheet" - New York")
![Form DOH-3867 "Complaint Form" - New York](https://data.templateroller.com/pdf_docs_html/2067/20673/2067356/form-doh-3867-complaint-form-new-york.png "Form DOH-3867 "Complaint Form" - New York")
![Form DOH-3848 "Semi-annual Controlled Substance Inventory Form for EMS Agencies" - New York](https://data.templateroller.com/pdf_docs_html/2032/20329/2032987/form-doh-3848-semi-annual-controlled-substance-inventory-form-for-ems-agencies-new-york.png "Form DOH-3848 "Semi-annual Controlled Substance Inventory Form for EMS Agencies" - New York")
![Form DOH-4275 "Application for Registration to Accept Home Generated Sharps for Safe Disposal" - New York](https://data.templateroller.com/pdf_docs_html/2067/20673/2067354/form-doh-4275-application-for-registration-to-accept-home-generated-sharps-for-safe-disposal-new-york.png "Form DOH-4275 "Application for Registration to Accept Home Generated Sharps for Safe Disposal" - New York")
![Form DOH-4380 "Mail-In Application for Copy of Birth Certificate" - New York](https://data.templateroller.com/pdf_docs_html/2011/20113/2011387/form-doh-4380-mail-in-application-for-copy-of-birth-certificate-new-york.png "Form DOH-4380 "Mail-In Application for Copy of Birth Certificate" - New York")
![Form DOH-2340 "Request for Approval of Disposal/Destruction of Controlled Substances" - New York](https://data.templateroller.com/pdf_docs_html/2032/20329/2032982/form-doh-2340-request-for-approval-of-disposal-destruction-of-controlled-substances-new-york.png "Form DOH-2340 "Request for Approval of Disposal/Destruction of Controlled Substances" - New York")
![Formulario LS223S "Formulario De Queja Sobre Normas Laborales" - New York (Spanish)](https://data.templateroller.com/pdf_docs_html/2011/20114/2011413/formulario-ls223s-formulario-de-queja-sobre-normas-laborales-new-york-spanish.png "Formulario LS223S "Formulario De Queja Sobre Normas Laborales" - New York (Spanish)")
![Form DOH-2094 "Loss of Controlled Substances Report" - New York](https://data.templateroller.com/pdf_docs_html/2032/20329/2032989/form-doh-2094-loss-of-controlled-substances-report-new-york.png "Form DOH-2094 "Loss of Controlled Substances Report" - New York")
![Form DOH-5273 "Application for Registration as a Controlled Substance Agent for a Facility Certified for Euthanasia of Animals" - New York](https://data.templateroller.com/pdf_docs_html/2032/20329/2032984/form-doh-5273-application-for-registration-as-a-controlled-substance-agent-for-a-facility-certified-for-euthanasia-of-animals-new-york.png "Form DOH-5273 "Application for Registration as a Controlled Substance Agent for a Facility Certified for Euthanasia of Animals" - New York")
![Form DOH-2794 "Application for the Uninsured Care Programs" - New York](https://data.templateroller.com/pdf_docs_html/2032/20329/2032975/form-doh-2794-application-for-the-uninsured-care-programs-new-york.png "Form DOH-2794 "Application for the Uninsured Care Programs" - New York")
![Form DOH-4332 "Application for Initial Certification as a Euthanasia Technician for Animals" - New York](https://data.templateroller.com/pdf_docs_html/2032/20329/2032986/form-doh-4332-application-for-initial-certification-as-a-euthanasia-technician-for-animals-new-york.png "Form DOH-4332 "Application for Initial Certification as a Euthanasia Technician for Animals" - New York")
![Form DOH-4333 "Application for Registration of an Incorporated Society or Municipal Animal Control Facility to Euthanize Animals" - New York](https://data.templateroller.com/pdf_docs_html/2011/20113/2011390/form-doh-4333-application-for-registration-of-an-incorporated-society-or-municipal-animal-control-facility-to-euthanize-animals-new-york.png "Form DOH-4333 "Application for Registration of an Incorporated Society or Municipal Animal Control Facility to Euthanize Animals" - New York")
![Form DOH-5069 "Access to Services in Your Language: Complaint Form" - New York (Bengali)](https://data.templateroller.com/pdf_docs_html/2033/20330/2033005/form-doh-5069-access-to-services-in-your-language-complaint-form-new-york-bengali.png "Form DOH-5069 "Access to Services in Your Language: Complaint Form" - New York (Bengali)")
