Nevada Department of Health and Human Services Forms

This form is used for amending or correcting a birth or death certificate in the state of Nevada.

This document is a tracking chart used in Nevada to monitor the cooling process of food items.

This Form is used for individuals in Nevada to self-report information or incidents.

This form is used for authorizing the use of a credit card in the state of Nevada.

This Form is used for physicians to supplement their application for mammography machine certification or renewal in Nevada.

This Form is used for reporting serious occurrences to the Nevada Division of Health Care Financing and Policy.

This document is used for obtaining medical clearance and certification for emergency admission of an allegedly mentally ill person to a mental health facility in Nevada.

This document is a waiver of liability, indemnification, and medical release specific to the Infant-At-Work Program in Nevada. It outlines the terms and conditions that participants must agree to in order to participate in the program.

This document is a discussion checklist for a pre-program meeting for the Infant-At-Work Program in Nevada. It outlines the topics to be covered and tasks to be accomplished during the meeting.

This Form is used for requesting permission to bring an infant to work in the state of Nevada.

This document outlines the individual work plan for employees participating in the Infant-At-Work Program in Nevada. It details the responsibilities and expectations for both the employee and employer during the program.

This document is for notifying employers about the intention to take break times and providing a place to express milk for nursing mothers in Nevada.

This document outlines the policies and procedures that govern the Family Resource Center in Nevada. It provides information on how the center operates and what services it offers to families in the community.

This Form is used for collecting information on the impact of proposed Health Information Exchange Regulation on small businesses in Nevada.

This form is used for applying for a child care stipend in Nevada.

This document outlines the rights and responsibilities that parents have in Nevada's early intervention program. It provides information on how parents can be involved in their child's development and access services and resources.

This document provides a manual for parents regarding early intervention services in Nevada. It is written in Spanish and offers information and guidance on accessing and utilizing these services for children in need.

This document is a handbook for parents in Nevada who have a child enrolled in the Early Intervention Services System (NEIS). It provides information and resources on the services and support available to families.

This form is used for referring individuals to the Early Intervention Program in the Northern Nevada region.

This form is used for referring individuals to the Early Intervention Program in the Southern Region of Nevada. It helps to identify children who may benefit from early intervention services to support their development and address any potential delays or disabilities.

This type of document is a Stakeholder Survey specific to the state of Nevada. It is used to gather feedback and input from stakeholders in Nevada for a particular project or initiative.

This document provides guidelines for implementing effective practices during transitions in the Nevada Early Intervention Services program.

This document for requesting assistance in Nevada.

This document is used to request an external review in Nevada. It is a model form provided in Appendix B.

This Form is used for creating a biography for centenarians in the state of Nevada. It may contain information about their life, achievements, and personal history.

This form is used for determining the eligibility for intellectual and developmental disabilities in the state of Nevada.

This document is used for establishing a formal agreement between a mentor and mentee in the Communication Access Services Program in Nevada.

This document is a professional development log specific to the state of Nevada. It is used to track and record professional development activities and progress for individuals working in various fields within Nevada.

This document outlines a professional development plan for individuals in Nevada, spanning a three-year cycle. It helps individuals set goals, acquire new skills, and advance their careers.

This document is a mentoring log for the Communication Access Services Program in Nevada. It keeps track of the mentorship activities and progress within the program.

This document describes the position of a Long Term Care Ombudsman volunteer in Nevada.

This document is used for applying for Medicaid benefits for individuals who have aged out of foster care in the state of Nevada.

This document notifies individuals in Nevada about a proposed placement. It provides information regarding a potential placement and is used to inform recipients of the details and purpose of the proposed placement.

This Form is used for authorizing the release of an infant in Nevada.

This Form is used for applying to become an adoptee in Nevada if you are 18 years old or older.

This Form is used for birth parents in Nevada to apply for adoption or to provide consent for the adoption of their child.

This Form is used for relatives applying for a specific purpose in the state of Nevada.

This document is used for obtaining the consent of a birth parent in Nevada to release information from the Adoption Reunion Registry.