Form LH-13 "Red Book - Local Health Emergency Contact Directory Account Creation and Access Request" - New Jersey

What Is Form LH-13?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2016;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form LH-13 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form LH-13 "Red Book - Local Health Emergency Contact Directory Account Creation and Access Request" - New Jersey

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New Jersey Department of Health
Office of Local Public Health
Red Book - Local Health Emergency Contact Directory
ACCOUNT CREATION AND ACCESS REQUEST
Instructions: This access request must be submitted by the Health Officer.  Please, complete the following information 
and send the completed form to contact.LHR@doh.nj.gov.  An account will be set up with permission for the individual 
listed to access the Red Book ‐ Local Health Emergency Contact Directory.  Please allow ten (10) business days for this 
request to be processed. 
First Name: __________________ Last Name: _____________________________________
Local Health Department: ______________________________________________________
Email: ____________________________ Telephone: ______________ Extension: ________
 - Yes
 - No
Does this person currently have a Hippocrates account?
 - Yes
 - No
Does this person need access to the Red Book directory?
If yes, what Red Book role should we assign to this individual?
 - View / Modify Records
 - View Only
 - Yes
 - No
Will this person also need access to the Local Health Report (LHR)?
If yes, what LHR role should we assign to this individual?
 - Health Officer (the health officer in charge)
 - Approver (a trusted supervisor)
 - Data Enterer
Comments: 
Health Officer Signature: __________________________________ Date: _______________
Office of Local Public Health
New Jersey Department of Health
P.O. Box 360
Trenton, NJ 08625-0360
contact.LHR@doh.nj.gov
LH‐13 
JUN 16 
New Jersey Department of Health
Office of Local Public Health
Red Book - Local Health Emergency Contact Directory
ACCOUNT CREATION AND ACCESS REQUEST
Instructions: This access request must be submitted by the Health Officer.  Please, complete the following information 
and send the completed form to contact.LHR@doh.nj.gov.  An account will be set up with permission for the individual 
listed to access the Red Book ‐ Local Health Emergency Contact Directory.  Please allow ten (10) business days for this 
request to be processed. 
First Name: __________________ Last Name: _____________________________________
Local Health Department: ______________________________________________________
Email: ____________________________ Telephone: ______________ Extension: ________
 - Yes
 - No
Does this person currently have a Hippocrates account?
 - Yes
 - No
Does this person need access to the Red Book directory?
If yes, what Red Book role should we assign to this individual?
 - View / Modify Records
 - View Only
 - Yes
 - No
Will this person also need access to the Local Health Report (LHR)?
If yes, what LHR role should we assign to this individual?
 - Health Officer (the health officer in charge)
 - Approver (a trusted supervisor)
 - Data Enterer
Comments: 
Health Officer Signature: __________________________________ Date: _______________
Office of Local Public Health
New Jersey Department of Health
P.O. Box 360
Trenton, NJ 08625-0360
contact.LHR@doh.nj.gov
LH‐13 
JUN 16