New Hampshire Department of Health and Human Services Forms

This form is used for applying for an annual mobile food unit license in New Hampshire.

This form is used for reporting family information of children with severe disabilities in New Hampshire.

This form is used for authorizing the release of criminal history record information in the state of New Hampshire.

Este formulario se utiliza para el Acuerdo del Programa de Experiencia Laboral (WEP) en el estado de New Hampshire.

This form is used for requesting certification of a provider of community residence and/or community participation services in the state of New Hampshire.

This Form is used for requesting the deactivation of a card in the state of New Hampshire.

This document is a request form for interim control use in the state of New Hampshire.

This form is used for applying for an annual license for a food processing plant in New Hampshire.

This Form is used for applying for child support services in New Hampshire for the obligor or putative father.

This document is an agreement for the authorized site in the state of New Hampshire. It specifies the terms and conditions for using a particular location for a specific purpose.

This document is used by clients in New Hampshire to request access to their own confidential information.

This form is used to file a complaint against a vendor participating in the WIC program in New Hampshire.

This Form is used for confidential reporting of sexually transmitted infections (STIs) in the state of New Hampshire.

This form is used for reporting life safety issues and concerns in the Child Protective Services Program in New Hampshire.

This document provides information on community-based COVID-19 testing options in New Hampshire. It includes details on locations, testing procedures, and availability.

This document provides information on the available options for Covid-19 PCR testing in New Hampshire.

This form is used for establishing legal paternity in the state of New Hampshire. It is a sample affidavit that can be used as a template for filing a paternity claim.

This Form is used for authorized users in New Hampshire to document their training, experience, and preceptor attestation for DHHS/RHS-1M supplement B sources.

This Form is used for applying for the Ryan White Care program in the state of New Hampshire. The program provides HIV/AIDS-related medical care and support services to eligible individuals.

This type of document is used for religious exemption from vaccination in daycare centers/schools in New Hampshire.

This document is a confidentiality agreement for the New Hampshire Public Health Laboratories (NH PHL) LIMS system. It outlines the terms and conditions regarding the protection of sensitive information and data confidentiality.

This document is used to express disagreement with the decision to refuse newborn screening in the state of New Hampshire.

This document is used for requesting clinical laboratory tests in New Hampshire.

This document is used to conduct a clinical record review in the state of New Hampshire. It is a process for assessing and evaluating patient records in order to ensure quality and compliance with regulations.

This form is used for reporting complaints about stores or participants to the State WIC Program in New Hampshire.

This form is used for requesting service authorization for diagnostic imaging in the state of New Hampshire under the Fee-for-Service (FFS) system.

This Form is used for requesting a religious exemption from childcare or school immunization requirements in the state of New Hampshire.

This document is used for obtaining passive parental permission for youth to participate in the Youth Risk Behavior Survey (YRBS) in New Hampshire.

This document is used for authorizing the New Hampshire Department of Health and Human Services to disclose protected or confidential information to a third party.

This form is used for requesting immunization/vaccination records in the state of New Hampshire.