Illinois Department of Public Health Forms

This Form is used for employee symptom screening in non-healthcare workplaces in Illinois. It helps to ensure a safe and healthy work environment.

This Form is used for making changes to the laboratory name, address, and director in the state of Illinois. It is necessary to update these changes with the appropriate authorities to ensure accurate record-keeping.

This Form is used for involuntary termination of residency in assisted living and shared housing in Illinois.

This document is used for changing the type of CLIA certificate in the state of Illinois.

This document is for requesting approval for health wellness events in Illinois. It outlines the requirements and procedures for hosting such events.

This document is used for disclosing a change of ownership or tax identification in the state of Illinois. It is important to update this information accurately to comply with state laws and regulations.

This document is used for providing a sworn statement to support photographic evidence or to verify the authenticity of a photograph in the state of Illinois.

This form is used for requesting Covid-19 or Influenza laboratory tests in Illinois.

This form is used for requesting an exemption from the dispensary sale surcharge in the state of Illinois.

This type of document is the application form for the Podiatric Scholarship Program in Illinois. It is used to apply for a scholarship for podiatry studies.

This form is used for authorizing the release of immunization records in the state of Illinois. It allows individuals to provide consent for their immunization records to be shared with designated parties, such as schools or healthcare providers. This document ensures that the necessary information is disclosed and readily available when needed.

This document is for pre-approval of Fuzeon (Enfuvirtide) medication through the Medication Assistance Program (MAP) in Illinois.

This form is used for pre-approval of Hepatitis C medication through the Medication Assistance Program (MAP) in Illinois.

This document is used for obtaining prior authorization for the medication Valganciclovir Hydrochloride (Valcyte) in the state of Illinois.

This form is used for pre-approval of hormone therapy under the Medication Assistance Program (MAP) in Illinois.

This form is used for changing the status of a laboratory in Illinois. It is used to notify the relevant authorities about any changes in the operational status or ownership of a laboratory.

This form is used for submitting a food investigation report in Illinois.

This form is used for submitting environmental samples in the state of Illinois. It serves as a cover sheet for the samples being submitted for testing or analysis.

This document is an application for individuals in Illinois who want to become certified plumbing inspectors. It is used to apply for the examination required for certification.

This form is used for notifying the state of Illinois about any changes in the laboratory name, address, or director.

This form is used for ordering resources and materials related to the Illinois Early Hearing Detection and Intervention Program.

Este formulario se utiliza para proporcionar prueba de examen dental para estudiantes en Illinois.

This document is a checklist for men's health screening tests in Illinois. It provides a list of recommended tests to stay healthy and prevent potential health issues.

This form is used for applying for a lead worker position in the state of Illinois.

This document is a questionnaire used in Illinois to assess the risk of prenatal lead exposure. It helps identify potential sources of lead and provides guidance on reducing or eliminating exposure.

This document is used for registering cannabis-infused products in the state of Illinois.

This form is used to determine the bed capacity of a specialized mental health rehabilitation facility in Illinois. It helps in planning and managing the facility's resources to provide adequate care to individuals with mental health needs.

This form is used for authorizing the exchange of data in Illinois.

Este formulario se utiliza para negar el intercambio de datos en el Registro de Adopciones del Estado de Illinois.

This Form is used for requesting a non-certified copy of an original birth certificate for a biological parent in Illinois in Spanish.