Pennsylvania Department of Health Forms

This Form is used for authorizing the mailing of a certificate to a temporary address in Pennsylvania due to a recent natural disaster.

This Form is used for renewing a dealer license in the state of Pennsylvania. It is necessary for dealers to submit this application to continue operating legally.

This Form is used for renewing the fitter license in Pennsylvania.

This Form is used for applying for a fetal death certificate in the state of Pennsylvania.

This form is used for requesting to modify a child's birth record in Pennsylvania if the child is between the ages of 1 year and less than 7 years old.

This form is used for requesting a modification to an adult's birth record in Pennsylvania when they are 18 years old or above.

This form is used for requesting a modification to the birth record of a teenage child who is between the ages of 14 and 18 years old in the state of Pennsylvania.

This form is used for requesting to modify an infant's birth record in Pennsylvania if the child is less than 1 year old.

This form is used for requesting a modification of a preadolescent child's birth record in Pennsylvania who is between 7 and 14 years old.

This Form is used for applying for recognition in the voluntary rescue service in Pennsylvania.

This document is for Pennsylvania residents who need to apply for a birth certificate and have their fees waived due to a natural disaster. You can use this form if you were affected by a disaster and need to obtain a birth certificate without paying the usual fees.

This document is used for submitting reimbursement claims for healthcare expenses in Pennsylvania using the non-network direct reimbursement method.

This document authorizes the release of immunization records in the state of Pennsylvania. It allows healthcare providers or schools to obtain a person's immunization history for various purposes.

This form is used for reporting complaints regarding clinical laboratories in Pennsylvania.

This form is used for transferring patient care information during emergency medical services (EMS) in Pennsylvania.

This document is a questionnaire used in Pennsylvania to assess human exposure to rabies. It helps determine the risk of rabies infection in individuals who may have been exposed to the disease.

This document is an agreement for healthcare providers in Pennsylvania to participate in the state's Immunization Program.

This Form is used for applying for a birth certificate in Pennsylvania with fees waived for foster and juvenile justice-involved individuals.

This document is used for submitting an annual status report in the state of Pennsylvania. It provides a comprehensive update on the current status and progress of a specific entity or organization.