New Hampshire Department of Health and Human Services Forms

This Form is used for reporting Lyme Disease cases in New Hampshire by health care providers.

This document is a list and log for healthcare personnel in New Hampshire who have had contact with individuals suspected or confirmed to have Ebola. It helps in tracking and monitoring potential exposure to the virus in order to maintain public health safety.

This form is used for assessing and measuring abnormal involuntary movements in individuals. It is commonly used in the state of New Hampshire.

This form is used for physicians and psychologists in New Hampshire to provide a statement of their capabilities. It is required for certain purposes such as disability claims or medical evaluations.

This form is used for authorizing the release of protected health information in New Hampshire.

This document is used for applying for Medicaid in New Hampshire through the Presumptive Eligibility CFI/HCBC program.

This document is used for reimbursement agreements and acknowledgments in the state of New Hampshire. It is a form that helps individuals and organizations in the state to facilitate reimbursements.

This Form is used for screening purposes in the state of New Hampshire.

This document is for acknowledging the choice of presumptive Medicaid eligibility for the home and community based care program in New Hampshire.

This Form is used for requesting to determine Presumptive Eligibility (PE) in New Hampshire.

This form is used for applying for Family Planning Medical Assistance (FPMA) in New Hampshire.

This form is used for determining the incapacity status in New Hampshire.

This Form is used for declaring an Authorized Representative (AR) in New Hampshire.

This Form is used for submitting the declaration of authorized representative (RA) in New Hampshire.

This document is used for applying for health coverage and financial assistance in New Hampshire.

This form is used for the certification of continuous absence in New Hampshire.

This Form is used for attesting and verifying the disaster experienced by the household receiving food stamps in New Hampshire.

This Form is used for recording observations during an interview in New Hampshire. It helps to document important details and information.

This form is used for applying for Medicaid Presumptive Eligibility (PE) in the state of New Hampshire.

This type of document is used to apply for Presumptive Eligibility (PE) for Medicaid in New Hampshire.

This form is used for notifying individuals in New Hampshire about their presumptive eligibility for certain benefits.

This form is used for attestation and verification of a food stamp household disaster in New Hampshire.

This document is used to report a new adverse event in the state of New Hampshire.

This Form is used for citizens of New Hampshire to request assistance from the Department of Foreign Affairs (DFA) in cases requiring support for a community or town.

This form is used for declaring expenses in the state of New Hampshire. It is an affidavit that allows individuals to provide a detailed account of their incurred expenses.

This document is used for making a sworn statement in the context of a residential program in the state of New Hampshire.

This form is used for authorizing someone to administer prescription and non-prescription medication in the state of New Hampshire.

This document grants permission for a child to be released from the care of Child Care Personnel in New Hampshire.

This Form is used for parents in New Hampshire to authorize the use of an electronic monitor to supervise their child.

This document provides information about child care personnel in New Hampshire. It includes details such as their qualifications, background checks, and employment history.

This document is a sample of a children's attendance form specific to the state of New Hampshire. It is used to track and record the attendance of children in a particular setting, such as a school or daycare facility.

This document is used for tracking the schedule and attendance of children and staff in New Hampshire. It helps to ensure proper staffing and record-keeping in child care facilities.

This document outlines emergency procedures specific to the state of New Hampshire. It provides guidance and instructions on what to do in case of various emergencies, such as natural disasters or public safety threats.