Nevada Department of Health and Human Services Forms

This form is used for reporting the completion of an Emergency Medical Services (EMS) course in Nevada.

This document is a checklist for driving instructors in Nevada. It contains important guidelines and requirements that instructors must follow while teaching driving lessons in the state.

This document is for applying for authorization to operate a continuing education training center for the Emergency Medical Systems Program in Nevada.

This document is used for reporting and monitoring infection control transfers between healthcare facilities in Nevada.

This form is used for obtaining consent to release protected health information (PHI) in the state of Nevada.

This form is used for patients in Nevada to give consent for the release of their protected health information.

This Form is used for obtaining consent to release protected health information for outpatient services in Nevada.

This document form is used for obtaining protected health information in Nevada.

This form is used for determining eligibility and collecting financial information for insurance in the state of Nevada.

This Form is used for referring someone to a program or service in the state of Nevada.

This form is used for completing a gender identity questionnaire in the state of Nevada. It is used to gather information about gender identity for statistical purposes.

This Form is used for collecting racial identity information in Nevada.

This document is a Risk Behavior Questionnaire specific to the state of Nevada. It is used to gather information about risky behaviors of individuals in Nevada.

This Form is used for conducting surveys to determine the eligibility and scope of healthcare providers in Nevada.

This Form is used for the annual client review process in Nevada to determine universal eligibility for various benefits.

This document is a cover page form used for site visits in the Ryan White Part B Program in Nevada.

This Form is used for new clients to apply for universal eligibility for the Nevada Ryan White Parts A, B, C, and D programs. It provides common guidance for completing the application.

This form is used for conducting a survey during a site visit to evaluate the quality management of the Ryan White Part B Program in Nevada.

This form is used for applying for universal eligibility for the Ryan White Parts A, B, C, and D programs in Nevada. It involves a six-month self-attestation process.

This Form is used for creating, changing, or deleting user accounts in the Careware system for Nevada's Ryan White Part B program.

This form is used for a Data Use Agreement related to the Careware Guidance Documents in Nevada's Ryan White Part B program.

This document is for conducting a programmatic site visit survey in Nevada for the Ryan White Part B Program.

This document is a tool used in Nevada to assess the feasibility and readiness of integrated opioid treatment and recovery programs. It helps in evaluating the effectiveness and potential of such programs in addressing the opioid crisis.

This document is a Letter of Intent for applying for a Certificate of Need in the state of Nevada. It is used to express the intention to establish a new healthcare facility or make significant changes to an existing one.

This Form is used for requesting approval for a specific purpose in the state of Nevada.

This document is used for verifying the arrival of new physicians participating in the J-1 Physician Visa Waiver Program in Nevada.

This Form is used for physicians in Nevada who are applying for a change of status under the J-1 Physician Visa Waiver Program.

This form is used for referring underinsured patients in Nevada to the Vaccines for Children (VFC) program for vaccine coverage.

This form is used for requesting and reporting accountability of vaccines in Nevada.

This Form is used for requesting pickup of expired or spoiled vaccines through the Nevada State Immunization Program in Nevada.

This document is a survey for withdrawing participation in the Nevada State Immunization Program.

This form is used for reporting any incidents related to vaccines in the Nevada State Immunization Program.

This Form is used for updating provider information in Nevada's Immunization Program.

This form is used for changing the vaccine coordinator in Nevada's immunization program.

This form is used for transferring vaccines within the Immunization Program in Nevada. It is necessary for maintaining proper inventory and distribution of vaccines.

This document provides guidelines and procedures for monitoring the temperature of vaccine storage units in Nevada. It ensures that vaccines are stored at the appropriate temperature to maintain their effectiveness.

This document reports on the borrowing of vaccines in the Nevada State Immunization Program. It provides an overview of the vaccines that have been borrowed and the corresponding details.

This form is used for participating in the Nevada Webiz program in the state of Nevada. It is required for businesses looking to register and engage in various activities in the state.