Public Health Templates

This document provides an annual report on combined sewer overflows in New York. It includes information on the frequency and impact of these overflows on the city's sewer system.

This document is an annual report generated for landfills located in Utah. It provides information on the waste disposal activities, environmental impact, and compliance with regulations at these landfills.

This document is used for tracking the administration of 12 doses of Isoniazid-Rifapentine during Directly Observed Therapy (DOT) in Virginia.

This document is used for establishing an agreement between a patient and healthcare provider for direct observed therapy in Virginia.

This document is used for conducting the final contact investigation in Virginia.

This Form is used for recording any wasted Covid-19 vaccine doses in the state of Wisconsin.

This Form is used for tracking and documenting Histoplasmosis cases in Wisconsin.

This document is a form provided by the Wisconsin government to encourage residents to get vaccinated and prevent the spread of the flu. It contains information and resources for flu prevention and protection.

This Form is used for reporting changes to Medicaid benefits in Wisconsin for individuals who speak Hmong.

This document provides a summary overview of the latest statistics and data on heart disease and stroke in the United States. It includes important information about the prevalence, risk factors, and impact of these health conditions.

This document describes the process of repealing and replacing health-related tax policy in the United States. It provides information on changes to tax laws that impact healthcare and how they are being replaced with new policies.

This document is a waiver request form for the Child and Adult Care Food Program in Arkansas, specifically related to Covid-19.

This document is for parents in New Hampshire who do not wish to give their consent for their newborn to undergo repeat newborn screening.

This document is a questionnaire used in Michigan to gather information for contact tracing in relation to Covid-19.

This form is used for reviewing the fees for ambulance services in Prince Edward Island, Canada. It is designed to assess and potentially revise the charges associated with ambulance transportation.

This document is used for tracking the custody of influenza surveillance data in Washington, D.C. It ensures the proper chain of custody to maintain the integrity and security of the data.

This form is used for renewing Medi-Cal benefits in California for Hmong-speaking individuals.

This form is used for requesting a Fit Home Screening Test in Prince Edward Island, Canada.

This Form is used for applying for the Ryan White Care program in the state of New Hampshire. The program provides HIV/AIDS-related medical care and support services to eligible individuals.

This document is for changing the sample site for the Lead & Copper Rule in Iowa. It is used to comply with the state's regulations for monitoring lead and copper levels in drinking water.

This form is used for reporting cases of human rabies in the state of Washington. It is an important document for tracking and monitoring rabies in the population.

This form is used for certification of immunization status in Washington. It is available in both English and Dari languages.

This form is used for applying for approval to treat public water supply systems serving a population of 3,300 or less in Massachusetts.

This document outlines the Integrated Pest Management plan for school districts in California. It details guidelines and procedures for environmentally-friendly pest control in schools.

This document is used in Connecticut for conducting contact investigations related to Tuberculosis (TB) cases. It helps health officials gather information about individuals who may have been exposed to TB and work towards preventing further transmission of the disease.

This document is the OTC Synar Survey specific to the state of Arkansas. It is used to gather information about the sale and distribution of tobacco products to minors in retail establishments.

This document provides information about the contents of a Naloxone kit and the exchange procedure in Oakland County, Michigan. It is used to educate residents on how to properly use and exchange Naloxone, a medication used to reverse opioid overdoses.

This form is used for submitting samples of potentially rabid animals for testing in New Brunswick, Canada. It is important to follow the instructions provided to ensure the proper collection and submission of the sample. This is essential for the prevention and control of rabies in the province.

This document is used for recording monthly disinfection of spas in Inyo County, California. It helps ensure the cleanliness and safety of the spas in the county.