Kentucky Department for Public Health Forms

This Form is used for recording the administration of Covid-19 vaccines in Kentucky. The form is available in both English and Spanish.

This form is used for filing taxes with the Fiscal Court in the state of Kentucky. It is specifically designated as form CH-61.

This form is used for applying for employment in the state of Kentucky. It is an official application form provided by the Kentucky government.

This Form is used for conducting employee performance appraisals in the state of Kentucky.

This document is used for conducting an employee performance evaluation in the state of Kentucky. It helps employers assess and review their employees' job performance and provides a basis for making decisions related to promotions, pay raises, and professional development opportunities.

This form is used for requesting a certified copy of a death certificate in the state of Kentucky.

This Form is used for documenting patient encounters in Kentucky. It helps healthcare professionals record details about the patient's visit, including symptoms, diagnoses, treatments, and follow-up plans.

This document is used for packing and ordering fluoride supplement supplies in the state of Kentucky.

This form is used for placing telephone orders or verbal orders in the state of Kentucky.

This Form is used for recording the interval history and physical examination of adult patients in Kentucky. It is available in both English and Spanish languages.

This Form is used for recording interval check-ups and assessments for pediatric patients in Kentucky.

This form is used for documenting pediatric interval health check-ups in Kentucky. It is available in both English and Spanish.

This form is used for conducting a pediatric initial history and physical examination in Kentucky. It is available in both English and Spanish.

This form is used for collecting feedback from participants before and after a class or training session in Kentucky.

This Form is used for assessing the health risks of babies in Kentucky aged from birth to 12 months.

This form is used for assessing the risk of Hepatitis C Virus (HCV) infection in the state of Kentucky.

This form is used for logging patient information for HCV RNA quantitative testing in Kentucky.

This Form is used for conducting a Health Risk Assessment for children aged 7 through 10 years in the state of Kentucky.

This form is used for conducting a health risk assessment for children between the ages of 12 months to 6 years in Kentucky.

This Form is used for conducting a health risk assessment for adolescents aged 11 through 20 years in the state of Kentucky.

This form is used for conducting health risk assessments for adults aged 21 and older, as well as pregnant, postpartum, breastfeeding, and family planning patients of all ages in Kentucky.

This form is used for conducting a verbal lead risk assessment in the state of Kentucky. It helps in evaluating potential exposure to lead in residential properties.

This form is used for parents or guardians in Kentucky to decline required immunizations on religious grounds.

This form is used for perinatal hepatitis B prevention in infants in the state of Kentucky. It helps in tracking and preventing the transmission of hepatitis B from mother to child during the perinatal period.

This form is used for conducting HIV tests in the state of Kentucky.

This Form is used for recording sexual history and conducting physical exams in Kentucky.

This form is used for documenting sexual history and conducting a physical exam in the state of Kentucky. It is available in Spanish.

This form is used to request incentives and support through the Tuberculosis Incentive and Enabler Program in Kentucky.

This Form is used for declaring paternity and establishing the father's legal relationship with a child in Kentucky. The form is available in both English and Spanish.

This form is used for reporting an adoption in the state of Kentucky.

This form is used for applying for a certified copy of a stillbirth certificate in the state of Kentucky.