New York State Department of Health Forms

This document is used for authorization to release health information, including alcohol/drug treatment and mental health information, as well as confidential HIV/AIDS-related information in New York. It is available in French.

This form is used for authorizing the release of health information, including alcohol/drug treatment, mental health information, and confidential HIV/AIDS-related information. It is specific to the state of New York and has an Italian version available.

This Form is used for filing a complaint about a suspected violation of Article 27f in New York. The form is available in French (DOH-2865FR).

This form is used for authorizing the disclosure of health information, including information about alcohol/drug treatments and mental health, as well as confidential information related to HIV/AIDS. This form is specific to New York and is in Spanish.

This Form is used for reporting complaints related to the alleged violation of Article 27f in New York, specifically for Italian-speaking individuals.

This form is used for reporting complaints related to alleged violations of Article 27f in New York.

This form is used to apply for registration in the Expanded Syringe Access Program (ESAP) in New York. ESAP is a program that allows registered pharmacies and healthcare professionals to distribute sterile syringes and needles to individuals without a prescription.

This form is used for authorizing the release of health information and confidential HIV-related information in New York, with a Russian translation.

This form is used for authorizing the release of health information, including alcohol/drug treatment and mental health information, as well as confidential HIV/AIDS-related information in New York. It is available in Russian.

This Form is used for applying for a con or convention in New York. It provides instructions on how to fill out the application correctly.

This form is used for prospective Children's Camp Directors in New York to provide a certified statement.

This form is used for declaring additional staff qualifications for children's camps in New York.

This form is used for registering and monitoring children's camp facilities and staff in New York.

This form is used for creating a written plan checklist for children's camps in New York. It helps ensure the safety and well-being of children attending the camp.

This Form is used for the Swimming Pool & Bathing Beach Safety Plan Checklist in New York. It helps ensure the safety of swimming pools and beaches by providing a checklist for owners and operators to follow.

This form is used for applying for a home care licensure in New York.

This document is for applying to be a licensed home care services agency in New York.

This form is used for applying to conduct a pharmaceutical collection event for controlled substances in New York.

This form is used for obtaining a Certificate of Need to possess hypodermic syringes and needles in the state of New York. It is required for individuals or organizations that need to legally possess these medical supplies.

This Form is used for submitting an Engineering Report for Bathing Beaches in New York.

This document is used for appointing a representative to control the disposition of remains in New York.

This Form is used for requesting prior approval for orthodontic and orthodontia-related services in New York.

This checklist is for adult hospital, hospice or nursing home patients in New York who do not have the capacity to make medical decisions and do not have a health care proxy. It outlines the steps for selecting a surrogate from the surrogate list, who will make decisions on behalf of the patient.

This Form is used for adult patients in New York who do not have a health care proxy and are completing a Molst form in the community.

This form is used for applying for a license to engage in a controlled substance activity in the state of New York.

This form is used for submitting complaints related to emergency medical services in the state of New York. It allows individuals to report any concerns or issues they have experienced with the quality of care provided by EMS providers.

This form is used for applying for an EMS operating certificate in New York.

This form is used for updating information on certified EMS agencies in New York.

This Form is used for applying for new service, expanding the primary operating territory, or transferring ownership in New York.

This Form is used for affirming fitness and competency in the state of New York.