Illinois Department of Public Health Forms

This document is for waiving the requirement for complete lead service line replacement in Illinois.

This Form is used for waiving the requirement of an eye examination in Illinois.

This form is used for applying for a non-commercial business license in the field of structural pest control in the state of Illinois.

This form is used for abstracting medical charts related to cases of pediatric hepatitis of unknown cause in the state of Illinois.

This tool is used to screen visitors for Covid-19 in the state of Illinois. It helps identify potential symptoms and risk factors to help prevent the spread of the virus.

This Form is used for requesting an exemption from the vision exam requirement in Illinois.

Este informe del examen de la vista es específico para el estado de Illinois. Proporciona los resultados y detalles del examen de la vista realizado en Illinois.

This document provides instructions for collecting a stool specimen for Norovirus analysis in Illinois. It guides patients on how to properly collect and submit their sample for testing.

This document provides instructions for the patient on how to collect a stool sample for bacteria analysis using a Cary-Blair vial. It is specific to Illinois.

This document provides instructions for patients in Illinois on how to collect a stool specimen for bacterial analysis using a Cary Blair vial.

This type of document is a Directly Observed Therapy (DOT) Agreement for the Treatment of Tuberculosis (TB) in Illinois.

This type of document is a Patient Treatment Release Form specifically for use in Illinois. It is used to give consent for medical treatment and release healthcare providers from liability.

This document is a questionnaire for gathering information about multiple hospice locations in Illinois. It is used to collect data about various hospice facilities in the state.

This Form is used for renewing the licensure of Ambulatory Surgical Treatment Centers in the state of Illinois.

This Form is used for renewing a Pediatric Plan under the Edap and Sedp programs in Illinois.

This document is used for renewing the PCCC and EDAP pediatric plan in the state of Illinois.

This type of document, known as a Certificate of Free Sale, is used to certify that a product being exported from Illinois is freely sold and meets all the necessary regulatory requirements. The document includes an invoice number for reference.

This document is used to inform nursing home residents in Illinois about an involuntary transfer or discharge and provides them with the opportunity for a hearing.

This form is used for applying for an initial license to operate a home health, home services, or home nursing agency in the state of Illinois.

This Form is used for applying for a J-1 Visa Waiver in the state of Illinois. The J-1 Visa Waiver Program allows certain foreign exchange visitors to apply for a waiver of the two-year home-country physical presence requirement.

This form is used for the treatment plan of active tuberculosis (TB) in Illinois. It outlines the steps and medications necessary to treat the disease effectively.

This document outlines the plan for screening individuals for tuberculosis in Illinois correctional facilities.

This document provides a follow-up report on a patient in Illinois who has been diagnosed with tuberculosis. It includes information on the patient's progress, treatment, and any necessary follow-up measures.

This document is used to indicate the refusal of medical care in the state of Illinois. It allows individuals to decline certain treatments or procedures for themselves.

This Form is used for requesting information about special flood hazard areas in Illinois. It helps residents determine whether their property is at risk of flooding.

This type of document is used for registering tissue and sperm banks in the state of Illinois.

This document is used for tracking and recording the results of drug residue screenings in Illinois.

This type of document provides instructions for completing a Drug Residue Screening Log in the state of Illinois. It guides individuals on how to accurately track and record drug residue testing for various purposes.