Indiana State Department of Health Forms

This form is used for reporting confidential cases of sexually transmitted diseases (STDs) in the state of Indiana.

This document is used for making a reimbursement claim for tuberculosis treatment at a hospital in Indiana.

This form is used for the Adoption Matching Program in Indiana. It collects information about the birth parent's contact preferences in the adoption process.

Use this legal document that specifies the type of medical care in Indiana that an individual does or does not want in the event they are unable to communicate their wishes. The will comes into play only when faced with a life-threatening condition and unable to assert specific desires regarding treatment.

This form is used for investigating Q-Fever cases in the state of Indiana.

This form is used for conducting the initial health assessment of refugees in Indiana before they can access certain healthcare services.

This form is used for filing a paternity affidavit with the local health department in Indiana for a child who is more than 60 days old.

This form is used for conducting a case investigation of Hepatitis B and Delta Hepatitis in Indiana.

This Form is used for hospitals in Indiana to establish paternity by filling out an affidavit.

This Form is used for filing a Paternity Affidavit upon marriage in the state of Indiana.

This form is used for requesting health coverage in Indiana. It is specifically designed for Spanish-speaking individuals in the state.

This Form is used for applying for a license to operate a hospital in Indiana.

This document is used for an Individual User Agreement in the state of Indiana. It outlines the terms and conditions for an individual to use certain services or access certain information.

This Form is used for schools in Indiana to establish an individual user agreement with students.

This document is used for providers in Indiana to enroll in the state's healthcare provider network.

This Form is used for submitting fees for the Putative Father Registry in Indiana.

This form is used for transmitting adoption history fees in the state of Indiana.

This document is a confidentiality and user agreement specifically for terminated pregnancies in the state of Indiana. It outlines the terms and conditions regarding the privacy and protection of sensitive information related to terminated pregnancies.

This form is used for requesting a specimen of rabies in Indiana.

This document provides instructions and guidelines for collecting a water sample in Indiana to test for fluoride levels.

This document provides information on the chemical examination of solids in the state of Indiana. It outlines the procedures and requirements for conducting chemical analyses on solid materials, and ensures that the results are accurate and reliable.

This document is used for submitting paint chips to an environmental lead laboratory in Indiana.

This form is used for submitting dust wipe samples to the Environmental Lead Laboratory in Indiana for testing and analysis.

This form is used for applying for a provisional or student permit in the state of Indiana.

This type of document, State Form 46889 Annual Calibration Summary, is used for recording and summarizing the results of annual calibrations for equipment and tools in the state of Indiana. It helps ensure accurate measurements and compliance with calibration standards.

This form is used for reporting facility information in the state of Indiana.

This document is used for the initial commissioning summary of the Therapy Accelerator in the state of Indiana. It provides details about the setup and initial functioning of the accelerator for therapy services.