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364
![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 2015 "Verification of Medicaid Transportation Abilities" - New York](https://data.templateroller.com/pdf_docs_html/1729/17291/1729190/form-2015-verification-medicaid-transportation-abilities-new-york.png "Form 2015 "Verification of Medicaid Transportation Abilities" - New York")
Form 2015 "Verification of Medicaid Transportation Abilities" - New York
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-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-4359 "Physician's Order for Personal Care/Consumer Directed Personal Assistance Services" - New York](https://data.templateroller.com/pdf_docs_html/238/2385/238576/form-doh-4359-physician-s-order-personal-care-consumer-directed-personal-assistance-services-new-york.png "Form DOH-4359 "Physician's Order for Personal Care/Consumer Directed Personal Assistance Services" - New York")
Form DOH-4359 "Physician's Order for Personal Care/Consumer Directed Personal Assistance Services" - New York
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-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-89 "Certified Class List for Ancillary EMS Training Courses" - New York
Size: 44 KB
2 pages
![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-51 "Supplemental Report of Given Name" - New York](https://data.templateroller.com/pdf_docs_html/2100/21007/2100757/form-doh-51-supplemental-report-of-given-name-new-york.png "Form DOH-51 "Supplemental Report of Given Name" - 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-297 "Application for Correction of Certificate of Birth" - New York](https://data.templateroller.com/pdf_docs_html/2100/21007/2100756/form-doh-297-application-for-correction-of-certificate-of-birth-new-york.png "Form DOH-297 "Application for Correction of Certificate of Birth" - New York")
![Form DOH-299 "Application for Correction of Certificate of Death" - New York](https://data.templateroller.com/pdf_docs_html/2103/21038/2103876/form-doh-299-application-for-correction-of-certificate-of-death-new-york.png "Form DOH-299 "Application for Correction of Certificate of Death" - 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-4329 "Official New York State Prescription Registration" - New York](https://data.templateroller.com/pdf_docs_html/2237/22373/2237338/form-doh-4329-official-new-york-state-prescription-registration-new-york.png "Form DOH-4329 "Official New York State Prescription Registration" - New York")
![Form DOH-4331 "Quarterly Controlled Substance Inventory Form for Incorporated Societies and Municipal Animal Control Facilities" - New York](https://data.templateroller.com/pdf_docs_html/2212/22125/2212551/form-doh-4331-quarterly-controlled-substance-inventory-form-for-incorporated-societies-and-municipal-animal-control-facilities-new-york.png "Form DOH-4331 "Quarterly Controlled Substance Inventory Form for Incorporated Societies and Municipal Animal Control Facilities" - New York")
![Form DOH-5733 "Controlled Substance Inventory for Drop Boxes in Bne Licensed Facilities" - New York](https://data.templateroller.com/pdf_docs_html/2127/21272/2127290/form-doh-5733-controlled-substance-inventory-for-drop-boxes-in-bne-licensed-facilities-new-york.png "Form DOH-5733 "Controlled Substance Inventory for Drop Boxes in Bne Licensed Facilities" - New York")
![Form DOH-3474 "Nonhospital Order Not to Resuscitate (DNR Order)" - New York](https://data.templateroller.com/pdf_docs_html/2100/21005/2100519/form-doh-3474-nonhospital-order-not-to-resuscitate-dnr-order-new-york.png "Form DOH-3474 "Nonhospital Order Not to Resuscitate (DNR Order)" - New York")
![Form DOH-5003 "Medical Orders for Life-Sustaining Treatment (Molst)" - New York](https://data.templateroller.com/pdf_docs_html/2127/21272/2127291/form-doh-5003-medical-orders-for-life-sustaining-treatment-molst-new-york.png "Form DOH-5003 "Medical Orders for Life-Sustaining Treatment (Molst)" - New York")
Form DOH-5003 "Medical Orders for Life-Sustaining Treatment (Molst)" - New York
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](https://data.templateroller.com/pdf_docs_html/2100/21007/2100760/form-doh-5721-affidavit-to-correct-name-or-gender-of-parent-for-a-person-16-years-of-age-or-under-new-york.png "Form DOH-5721 "Affidavit to Correct Name or Gender of Parent for a Person 16 Years of Age or Under" - New York")
![Form DOH-5722 "Affidavit to Correct Name or Gender of Parent for a Person 17 Years of Age or Older" - New York](https://data.templateroller.com/pdf_docs_html/2100/21007/2100762/form-doh-5722-affidavit-to-correct-name-or-gender-of-parent-for-a-person-17-years-of-age-or-older-new-york.png "Form DOH-5722 "Affidavit to Correct Name or Gender of Parent for a Person 17 Years of Age or Older" - New York")
