New York State Department of Health Forms

321
total templates

Documents

321

OCA Official Form 960 "Authorization to Release Health Information Pursuant to Hipaa" - New York

Rate (4.8 / 5) 18 votes
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 2015 "Verification of Medicaid Transportation Abilities" - New York

Rate (4.5 / 5) 44 votes
Size: 188 KB
2 pages

This is a form used by the residents of New York to request a specific mode of transportation which is necessary because they are unable to use public transportation to go to school, places of worship, stores, etc.

Form DOH-4359 "Physician's Order for Personal Care/Consumer Directed Personal Assistance Services" - New York

Rate (4.4 / 5) 58 votes
Size: 79 KB
4 pages

This form can be used by individuals who would like to apply for certain types of assistance in the state of New York, such as home care, help with skilled or personal tasks, housekeeping, etc.

Form DOH-4444 "Self-declaration of Income" - New York

Rate (4.5 / 5) 66 votes
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

Rate (4.7 / 5) 35 votes
Size: 230 KB
6 pages

Form DOH-30 "Adoptee Registration Form" - New York

Rate (4.6 / 5) 22 votes
Size: 1 MB
2 pages

Form DOH-80 "Notice of Course Cancellation" - New York

Rate (4.7 / 5) 18 votes
Size: 11 KB
1 page

Form DOH-89 "Certified Class List for Ancillary EMS Training Courses" - New York

Rate (4.8 / 5) 42 votes
Size: 44 KB
2 pages

Form DOH-65 "Application for Emergency Medical Services Certification" - New York

Rate (4.4 / 5) 18 votes
Size: 42 KB
2 pages

Form DOH-79 "Students Ineligible to Take the State Certifying Examination" - New York

Rate (4.8 / 5) 16 votes
Size: 60 KB
2 pages

Form DOH-372 "Application for Radiologic Technologist Licensure" - New York

Rate (4.4 / 5) 9 votes
Size: 389 KB
3 pages

Form DOH-348 "Application for Approval of Plans for Public Water Supply Improvement" - New York

Rate (4.8 / 5) 19 votes
Size: 115 KB
1 page

Form DOH-799 "Wic Medical Referral Form" - New York

Rate (4.6 / 5) 97 votes
Size: 47 KB
2 pages

Form DOH-352 "Application for Renewal of Certification Water System Operator" - New York

Rate (4.5 / 5) 14 votes
Size: 40 KB
2 pages

Form DOH-206 "Application for EMS Operating Certificate" - New York

Rate (4.7 / 5) 19 votes
Size: 147 KB
3 pages

Form DOH-367 "Children's Camp Facility and Staff Description" - New York

Rate (4.7 / 5) 58 votes
Size: 79 KB
2 pages

Form DOH-350 "Application for Certificate of Waiver From Disinfection Requirements" - New York

Rate (4.3 / 5) 14 votes
Size: 66 KB
2 pages

Form DOH-389 "Confidential Case Report" - New York

Rate (4.6 / 5) 19 votes
Size: 74 KB
1 page

Form DOH-359 "Annual Report on Violations of Watershed Rules and Regulations" - New York

Rate (4.5 / 5) 14 votes
Size: 190 KB
2 pages

Form DOH-166 "Controlled Substance Inventory Form" - New York

Rate (4.5 / 5) 12 votes
Size: 50 KB
1 page

Form DOH-695 "Screen Form" - New York

Rate (4.3 / 5) 89 votes
Size: 91 KB
7 pages

Form DOH-132 "Wic Medical Referral Form for Infants and Children" - New York

Rate (4.3 / 5) 71 votes
Size: 447 KB
3 pages

Form DOH-349 "Application for Certificate of Approval for Bottled or Bulk Water Facilities" - New York

Rate (4.7 / 5) 14 votes
Size: 1 MB
1 page

Form DOH-694 "Hospital and Community Patient Review Instrument (Hc-Pri)" - New York

Rate (4.8 / 5) 58 votes
Size: 42 KB
4 pages

Form DOH-360 "Water Systems Operation Report - Microbiological Sample Results" - New York

Rate (4.6 / 5) 21 votes
Size: 85 KB
2 pages

Form DOH-299 "Application for Correction of Certificate of Death" - New York

Rate (4.8 / 5) 9 votes
Size: 116 KB
2 pages

Form DOH-485 "Workers' Compensation Preferred Provider Organization (Ppo) Application" - New York

Rate (4.3 / 5) 66 votes
Size: 57 KB
4 pages

Form DOH-794 "Regulatory Compliance Statement" - New York

Rate (4.7 / 5) 48 votes
Size: 19 KB
2 pages

Form DOH-347 "Application for Approval of Backflow Prevention Devices" - New York

Rate (4.6 / 5) 23 votes
Size: 10 KB
1 page

Instructions for Form DOH-743 "Instructor Information Sheet" - New York

Rate (4.7 / 5) 10 votes
Size: 14 KB
1 page

Form DOH-3474 "Nonhospital Order Not to Resuscitate (DNR Order)" - New York

Rate (4.8 / 5) 24 votes
Size: 368 KB
1 page

Form DOH-5003 "Medical Orders for Life-Sustaining Treatment (Molst)" - New York

Rate (4.6 / 5) 50 votes
Size: 199 KB
4 pages

Form DOH-5721 "Affidavit to Correct Name or Gender of Parent for a Person 16 Years of Age or Under" - New York

Rate (4.5 / 5) 12 votes
Size: 104 KB
1 page

Form DOH-3867 "Complaint Form" - New York

Rate (4.6 / 5) 50 votes
Size: 310 KB
4 pages

Form DOH-3848 "Semi-annual Controlled Substance Inventory Form for EMS Agencies" - New York

Rate (4.8 / 5) 8 votes
Size: 1 MB
2 pages

Form DOH-4275 "Application for Registration to Accept Home Generated Sharps for Safe Disposal" - New York

Rate (4.4 / 5) 22 votes
Size: 1 MB
6 pages

Form DOH-4380 "Mail-In Application for Copy of Birth Certificate" - New York

Rate (4.6 / 5) 36 votes
Size: 390 KB
2 pages

Form DOH-2340 "Request for Approval of Disposal/Destruction of Controlled Substances" - New York

Rate (4.3 / 5) 12 votes
Size: 485 KB
1 page

Form DOH-2094 "Loss of Controlled Substances Report" - New York

Rate (4.3 / 5) 23 votes
Size: 1 MB
2 pages