Washington State Department of Health Forms

This document is for indicating the medical treatment preferences of individuals nearing the end of life in Washington state. Polst is used to document their choices regarding life-sustaining treatment.

This form is used for adoptees in Washington to request their original birth certificate from the sealed adoption file.

This type of document is used for applying for veterinary medicine, surgery, and dentistry in the state of Washington.

This Form is used for authorizing the use of medical marijuana in Washington state.

This document provides information on the results of a food establishment inspection in Washington. It includes details on the establishment's compliance with health and safety regulations, as well as any violations or issues that were found during the inspection.

This form is used for declaring the dissolution or invalidity of marriage or legal separation in the state of Washington.

This document is used for dissolving a domestic partnership in the state of Washington.

This form is used for reporting cases of perinatal hepatitis B in Washington state. It is used to gather confidential information about both the mother and the infant in order to track and monitor cases of hepatitis B transmission.

This document is used for requesting influenza vaccine administration in the state of Washington.

This form is used for pediatric care providers in Washington to document and track the care provided to infants born to mothers who are positive for Hepatitis B surface antigen (HBsAg). It serves as a checklist to ensure that proper medical interventions and follow-up measures are taken for these infants.

This Form is used for birth parents in Washington state to request their original birth certificate from a sealed adoption file.

This form is used for adoptees in Washington state to request the location and case number of their adoption.

This document is used for obtaining a Fetal Death Certificate in the state of Washington. It is used to officially record the death of a fetus.

This Form is used for applying for confidential birth information in the state of Washington.

This Form is used for reporting food and food-related bacteriology testing results in the state of Washington.

This form is used for the annual summary report of backflow prevention in severe health hazard facilities in Washington state.

This form is used for reporting the completion of construction projects in the state of Washington. It is required to document the final status and any outstanding issues of the construction project.

This document is used for reporting exceptions to high-health hazard premises isolation requirements in Washington on an annual basis.

This Form is used for applying to be listed as a Cross-connection Control Specialist (CCS) on the public list in Washington state.

This Form is used for submitting the Small Water System Management Program under the Washington Department of Health.

This Form is used for submitting an Engineering Design Review Report for distribution-related project submittal exceptions in Washington state.

This document is used for applying for project approval in Washington state. It is Form 331-149 issued by the Department of Health.

This form is used for submitting a water system plan in the state of Washington.

This Form is used for submitting an annual summary report for the Cross-connection Control Program in Washington state.

This document is used for confirming the water quality monitoring for GWI in Washington.

This Form is used for the Gwi Determination Process Purveyor's Choice Form in Washington.

This document is for reporting the water quality monitoring information in the state of Washington.

This form is used for identifying and designating potential sources of Gwi (Groundwater Under the Direct Influence) in Washington state.

This Form is used for the public notice certification of a nitrate MCL violation in Washington.

This document is for notifying water system users in Washington about a violation of the disinfection byproducts monitoring.

This form is used for reporting and documenting monthly violations of bromate monitoring in Washington's water systems.

This Form is used for reporting backflow incidents in Washington's Cross-connection Control Program.

This document is used for reporting violations of water system users regarding the levels of Total Trihalomethane (TTHM) and Haloacetic Acids (HAA5) in Washington.

This form is used for filing a complaint against a certified waterworks operator in Washington state.