Public Health Templates

This document is for reporting cases of lung injury associated with vaping or e-cigarette use in Washington state.

This Form is used for reporting cases of Salmonella and documenting laboratory results in the state of Washington.

This document is a request to destroy leftover samples collected during newborn screening in the state of Washington.

This Form is used for providing the Certificate of Immunization Status in Washington state. It is available in both English and Punjabi languages.

This document is used for proving an individual's immunization status in Washington state. It is available in both English and Chinese languages.

This document is for recording and verifying the immunization status of individuals in the state of Washington. It is available in both English and Korean languages.

This form is used for documenting the immunization status of individuals in Washington state. It is available in both English and Russian languages.

This form is used for reporting confidential cases of sexually transmitted diseases in Clark County, Washington.

This Form is used for reporting confidential cases of sexually transmitted diseases in Skagit County, Washington. It is important for tracking and monitoring public health.

This document provides a worksheet for recording and analyzing lead and copper test results in Vermont.

This document provides a report on a tuberculosis case in Washington, D.C. It includes relevant information about the case and its impact.

This form is used for reporting cases of reportable diseases in West Virginia. It helps health authorities track and monitor the spread of infectious diseases.

This form is used for high-risk occupations in Wisconsin to gather information about hepatitis A exposure.

This document outlines the emergency plan for relocating vaccines in the state of Wyoming. It provides guidelines and procedures in case of unforeseen events that may require vaccine relocation.

This document is a requisition for Enterovirus Testing in Wyoming. It is used to request laboratory testing for the presence of Enterovirus in individuals residing in Wyoming.

This document is used to request fluoride analysis in the state of Wyoming.

This document is a request form for the analysis of total coliforms in Wyoming.

This document for completing a medical questionnaire related to the vaccine proclamation in Washington state.

This document is used for conducting investigations related to Lyme Disease in Dutchess County, New York.

This document provides guidance for the reopening of businesses and activities in New Hampshire during the Covid-19 pandemic. It includes information on safety measures, capacity limits, and other guidelines to prevent the spread of the virus.

This document provides guidance for Maryland schools on implementing Covid-19 safety measures and protocols to protect students and staff.

This type of document is the Reopen America Act of 2020, proposed by Jamie Raskin from Maryland. It contains legislation aimed at reopening businesses and activities in the United States amidst the COVID-19 pandemic.

This document highlights the flexibilities provided by CMS (Centers for Medicare & Medicaid Services) to long-term care facilities, such as skilled nursing facilities and nursing facilities, in their fight against COVID-19. It includes various measures and guidelines to help these facilities manage and mitigate the impact of the pandemic.

This document provides information about the flexibilities granted by the Centers for Medicare & Medicaid Services (CMS) to home health agencies in response to the COVID-19 pandemic. It outlines the measures that home health agencies can take to combat the spread of the virus and ensure the safety of their staff and patients.

This document provides information on the number of COVID-related deaths in nursing homes across New York State.

This document outlines guidelines and strategies for conducting widespread testing to help reopen America safely during the COVID-19 pandemic.

This document outlines the plan for operating a public water system in Nevada. It details the steps and requirements for providing safe and clean drinking water to the public.

This document is an application form for the Drinking Water System Consolidation Program in Arizona. It is used to apply for the program which aims to consolidate drinking water systems in the state.

This form is used for conducting health screening related to Covid-19 in North Carolina.

This form is used for collecting and documenting patient information for possible human rabies cases.

This document is used for reporting and documenting complaints related to foodborne illnesses in the state of Ohio. Keep record of any incidents and details to ensure public health and safety.

This form is used for investigating cases of yersiniosis in Ohio.

This document is a worksheet used for monitoring and tracking cases of measles. It helps healthcare professionals gather important information about individuals who have been affected by the disease.

This form is used for reporting positive laboratory findings for reportable diseases in the state of Ohio.

This Form is used for reporting cases of Tickborne Rickettsial Disease.

This form is used for applying to the Ryan White Part B Program in Ohio.

This Form is used for reporting cases of Coccidioidomycosis (Valley Fever) in Ohio. It is part of an enhanced surveillance program to track and monitor the spread of this fungal infection.