Iowa Department of Health and Human Services Forms

This document is used to request immunization and health screening records through the Immunization Registry Information System (IRIS) in Iowa.

This form is used for conducting the initial health assessment of refugees in Iowa.

This document is an Authorized User Agreement for individuals who will be using the Immunization Registry Information System (IRIS) in the state of Iowa. It outlines the terms and conditions for accessing and using the IRIS system.

This form is used for monitoring the treatment of latent tuberculosis infection (LTBI) in Iowa. It helps the Tuberculosis Control Program track the progress of individuals receiving LTBI treatment.

This Form is used for transferring vaccines between VFC (Vaccines for Children) providers in Iowa.

This form is used to gather information about healthcare providers participating in the Vaccines for Children (VFC) Program in the state of Iowa. It helps ensure that eligible children have access to vaccines at no cost.

This form is used for enrolling healthcare providers in the Vaccines for Children (VFC) Program in Iowa. The VFC Program provides free vaccines to eligible children to protect against vaccine-preventable diseases.

This form is used for applying to become a provider for the Iowa Medicaid Universal Home-And Community-Based (HCBS) Waiver program. It is necessary to complete this application in order to be considered for eligibility to provide services under the waiver program.

This document is used to keep track of the immunizations received by adults in the state of Iowa. It helps to ensure that individuals are up to date with their vaccinations for various diseases.

This document is a log sheet for recording the temperature of a refrigerator in Fahrenheit units. It is specifically designed for use in Iowa.

This document is a temperature log for a Fahrenheit freezer in Iowa. It covers the first 15 days.

This document is required to confirm a dental screening has been conducted in Iowa according to state regulations. It is necessary for school registration, ensuring overall oral health, and tracking statewide dental health trends.

This form is used by childcare providers in Iowa to report the results of a physical examination. It ensures that the individual is physically capable of providing child care services.

This Form is used for designating an authorized representative to handle managed care appeals in Iowa.

This Form is used for reporting suspected cases of abuse involving dependent adults in Iowa.