New Hampshire Department of Health and Human Services Forms

This form is used for the surviving spouse or next of kin in New Hampshire who is seeking access to the medical records of a deceased person.

This form is used for registering a recovery house in the state of New Hampshire.

This Form is used for applying for reciprocal recognition of out-of-state machines in New Hampshire.

This document is a questionnaire used by Hampstead Hospital in New Hampshire for adult referrals. It is used to gather information about patients being referred to the hospital for treatment.

This document outlines the expectations and commitments for participants in the SNAP E&T program in the state of New Hampshire. It provides important information on what participants can expect and what is expected of them during their participation in the program.

This form is used for placing orders for materials related to the Immunization Program in New Hampshire. It allows individuals or organizations to request specific immunization-related materials.

This form is used for applying to become a certified and enrolled private behavioral health provider in New Hampshire.

This Form is used for requesting reimbursement of co-pays and deductibles through the HIPP program in New Hampshire.

This Form is used for documenting the cumulative occupational exposure history of individuals in New Hampshire. It is used by the DHHS/RHS (Department of Health and Human Services/Rural Health Services) to track and monitor potential health risks related to occupation.

This type of document is a confidential hepatitis B provider case report form specific to New Hampshire. It is used for reporting new diagnoses and perinatal exposures of hepatitis B in the state.

This form is used for requesting access to records in New Hampshire as per GM Form 512.

This form is used for transferring or revising certain documents in the state of New Hampshire.

This document is a checklist of items that need to be included in a New Hampshire Care Program Provider Agreement Cover Sheet. It ensures that all necessary information is included in the agreement.

This document is a tool used for assessing the care needs of individuals in residential services in the state of New Hampshire. It helps determine the level of care and support needed for individuals in these settings.

This form is used for requesting funds from the Laconia State School Trust Fund in New Hampshire.

This Form is used for indicating the training, experience, and preceptor attestation of an authorized medical physicist in New Hampshire.

This Form is used for reporting any incidents or situations where there is no evidence available in the state of New Hampshire. It helps in documenting and resolving cases when there is a lack of evidence.

This type of document is used for making referrals to the Bureau for Family Centered Services in New Hampshire. It helps individuals and families access necessary resources and support services.

This form is used for notifying a non-petitioned parent in a child abuse or neglect case in New Hampshire.

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

This form is used for conducting a prea vulnerability assessment in New Hampshire to evaluate the risk of victimization and/or sexually aggressive behavior. It helps to determine the overall risk level of individuals.

This form is used for applying for a Milk Sanitation License in the state of New Hampshire.

This form is used for referring a juvenile to a needs assessment in the state of New Hampshire regarding their involvement in the juvenile justice system.

This document is an application for a Milk Route Permit in the state of New Hampshire. It is used by individuals or businesses looking to transport and distribute milk products.

This form is used for reporting cases of psychotropic intoxication in the state of New Hampshire.

This Form is used for requesting NH Care in New Hampshire. (In Spanish)

This form is used for requesting funds from the Laconia State School Trust Fund in New Hampshire.

This document is used for the reimbursement process of tax refunds under the NH Care Program in New Hampshire. It outlines the agreement for receiving funds back from the state.

This form is used for withdrawing participation and deleting vaccination records from the immunization registry of New Hampshire.

This form is used for documenting the training and experience of an authorized user or radiation safety officer in New Hampshire. It is a supplement to Form RHS-1.

This Form is used for applying for reciprocity of radioactive material in New Hampshire.

This document is for individuals in New Hampshire who wish to apply as a volunteer for the LTC Ombudsman program.

This Form is used for authorized nuclear pharmacist training and experience and preceptor attestation in the state of New Hampshire.

This document is used for reviewing the certification records of a single staff member at a local agency in New Hampshire.