Arkansas Department of Health Forms

This document is used for justifying the budget of the Tobacco Prevention & Cessation Program in Arkansas.

This document is a technical proposal packet form used in Arkansas. It is used for submitting technical proposals for various projects or contracts in the state of Arkansas.

This form is used for applying to various programs and services offered by the state of Arkansas.

This form is used for applying to operate a temporary food establishment in Arkansas.

This form is used for authorizing the release of official immunization history to the Arkansas Immunization Registry (Webiz).

This form is used for unemancipated minors and women under legal guardianship or custodianship for incompetency in Arkansas to disclose and give consent for an abortion.

This form is used for applying for a massage therapy license in Arkansas if you are currently licensed in another state.

This form is used for applying for a medical particle accelerator in Arkansas.

This document provides a required notice to individuals who receive health care services at registered free or low-cost health care clinics in the state of Arkansas. It outlines important information and rights that patients should be aware of when seeking care at these clinics.

This Form is used for disclosing and certifying contracts and grants in Arkansas.

This document allows individuals in Arkansas to express their medical treatment preferences in end-of-life situations. It helps healthcare providers understand the patient's wishes for life-saving measures, resuscitation, and other treatments.

This document is an application for obtaining a competency license as an Assembly Repair Technician in the state of Arkansas.

This form is used for applying for an Assembly Tester Technician Competency License in Arkansas.

This document is used for applying for the reinstatement of a plumber's license in Arkansas.

This document is used for requesting approval for training in the Arkansas Water Operator Licensing Program in Arkansas.

This document is used for obtaining approval for operating a mobile food service area in the state of Arkansas.

This document provides information about a pre-planned healthcare program in Arkansas.

This document is for appointing a Medical Care Agent in Arkansas.

This document is used for applying to become a vendor for the WIC program in Arkansas.

This form is used for applying for a license to conduct a hospital or related institution in Arkansas. It is an addendum to the main application form.

This document outlines the action plan for converting a rural hospital into an emergency hospital in Arkansas.

This form is used for applying for a license to run a hospital or related institution in the state of Arkansas.

This document is an attestation statement used by rural emergency hospitals in Arkansas. It verifies that the hospital meets certain criteria to be designated as a rural emergency hospital.

This form is used for requesting user access to the Ed Hospital Hub system in Arkansas.

This document is used for completing a background check in the state of Arkansas.