Arkansas Department of Health Forms

This document is a notification of the registration of a norm facility in the state of Arkansas.

This form is used for the Military Reciprocity Program in Arkansas for Radiologic Technologist licensure.

This form is used for filing a complaint in the state of Arkansas.

This form is used for verifying licenses or certificates from other states when applying in Arkansas.

This document is an application for registration with the State Board of Registered Professional Sanitarians in Arkansas. It is used by individuals seeking to become registered professional sanitarians in the state.

This form is used for applying for a temporary license for cross-training in PET/Ct in the state of Arkansas.

This Form is used for requesting inactive or retired status in Arkansas.

This form is used to apply for accreditation to perform mammography under MQSA (Mammography Quality Standards Act) in Arkansas.

This Form is used for filing privacy complaints in the state of Arkansas.

This Form is used for reporting public complaints related to foodborne, waterborne, and enteric illnesses in Arkansas. Keep track of incidents and ensure the safety of the community.

This document is for conducting initial hearing screens or rescreens for infants in Arkansas after they have been discharged from the hospital.

This form is used for the initial screening of hearing in infants in the state of Arkansas.

This document is for the initial or reexamination auditory examination in Arkansas.

This document is for conducting infant hearing diagnostic tests in the state of Arkansas.

This document is a completion checklist for collecting newborn screening blood samples in Arkansas. It provides a list of steps to ensure that the collection process is done correctly.

This document is a sample student health screening report specific to the state of Arkansas. It provides an overview of a student's health status and serves as a record for healthcare professionals and educational institutions.

This document is used for reporting patient transfers from a lay midwife to a hospital in Arkansas.

This form is used for filing complaints regarding licensed lay midwifery programs in Arkansas.

This document is used for disclosing information related to the Limited Liability Company (LLC) in the state of Arkansas. It provides a summary of the company's structure, ownership, and other important details. It ensures transparency and compliance with state regulations.

This document is used for informing individuals about their right to refuse medical treatment or procedures in the state of Arkansas.

This document is used for obtaining an initial license or reactivating a license for the practice of law in Arkansas.

This document is used for keeping track of caseload and birth records for the LL.M. program in Arkansas.

This document is used for reporting incidents that occur in Arkansas. It is used to document the details of an incident and gather information for further investigation or legal purposes.

This document is used for establishing a formal agreement between a preceptor (mentor) and a transitional apprentice in the state of Arkansas. It outlines the terms and expectations of the apprenticeship and serves as a legal contract between both parties.

This Form is used for renewing a Transitional Apprentice Permit in Arkansas.

This document is used for renewing an LLM (Limited License Legal Technician) license in Arkansas.

This document is for establishing an agreement between preceptors and apprentices participating in the Narm Pep Apprenticeship Program in Arkansas. It outlines the responsibilities and expectations of both parties during the apprenticeship.

This form is used for applying for the Retired Physician Immunity Act in Arkansas.