New Hampshire Department of Health and Human Services Forms

This Form is used for managing the inventory disposition in the WIC (Women, Infants, and Children) program in New Hampshire.

This type of document is for requesting an immunization or vaccination record in New Hampshire.

This document is an application form for requesting access to limited use data sets in the state of New Hampshire.

This form is used for making corrections to the immunization or vaccination record in the state of New Hampshire.

This Form is used for obtaining prior authorization for Hyaluronic Acid Derivatives Injection in the Medicaid Fee-For-Service Program in New Hampshire.

This form is used for submitting an application to review the floor plan of a new food establishment in the state of New Hampshire. It is required to ensure compliance with health and safety regulations.

This form is used for getting to know an infant or toddler (0-3 years old) in the state of New Hampshire. It helps gather information about the child's development, health, and daily routines.

This Form is used for homeowners in New Hampshire to submit water test samples for analysis. It is a necessary step to ensure the quality and safety of their drinking water.

This form is used for foster parents in New Hampshire to file an insurance claim.

This Form is used for fire department inspections of apartment buildings in New Hampshire. It ensures compliance with fire safety regulations and helps ensure the safety of occupants.

This Form is used for reporting financial information on pre-adoptive and foster family care license applications in New Hampshire.

This document is used for reporting confidential information about communicable diseases in the state of New Hampshire.

This document is an Authorized User Agreement specific to the state of New Hampshire. It outlines the terms and conditions for individuals who are authorized to access certain systems or information in the state of New Hampshire.

This form is used for reporting adult HIV/AIDS cases in New Hampshire for patients who are 13 years of age or older.

This document is for extending the written certification in the Therapeutic Cannabis Program in New Hampshire.

This Form is used for reimbursement agreement and acknowledgment in New Hampshire.

This document provides a guide for evaluating local agency clinics in New Hampshire that participate in the Women, Infants, and Children (WIC) program. It outlines the criteria and standards for evaluating the clinics and ensuring the quality of services provided.

This Form is used for filing a grievance with the Ombudsman in New Hampshire.

This Form is used for the intake and eligibility determination process for the New Hampshire Wraparound (Fast Forward) program.

This document is an autism questionnaire designed for parents of children aged 12 and older in New Hampshire. It helps to assess autism symptoms in children and gather information for diagnosis and treatment.

This document is for submitting a floor plan application for beverage and bottled water businesses in the state of New Hampshire. It outlines the layout and specifications of the proposed facilities.

This document is for individuals or families in New Hampshire who are seeking services from the Bureau for Family Centered Services (BFCS). It is used to apply for various services available through BFCS, which aims to support and strengthen families in need.

This Form is used for verifying the independent status of a foster care youth for the purpose of FAFSA in the state of New Hampshire.

This document is a Cold Chain Incident Report form used by the New Hampshire Immunization Program in the event of any issues or incidents related to vaccine storage and handling.

This document is used for conducting a life safety report for a placement location in New Hampshire that accommodates one to three people. It assesses the safety measures and potential hazards in the location to ensure the well-being of the individuals residing there.

This document provides information and resources for parents in New Hampshire who have children with anxiety and obsessive/compulsive disorders. It offers guidance on understanding these conditions and how to support children through treatment.

This form is used to assess symptoms of depression in adolescents in the state of New Hampshire.

This form is used for nominating a health officer or deputy in New Hampshire.

This document is used for registering participants in the New Hampshire Syringe Services Program in New Hampshire.

This document is the New Hampshire WIC Program Manual Form for women. It provides guidelines and instructions for women participating in the WIC program in New Hampshire.

This document provides a sample template for Conflict of Interest and Separation of Duties policies in the state of New Hampshire. It outlines guidelines for ethical behavior and ensuring impartiality in decision-making processes within organizations and companies.

This document is for choosing not to participate in the immunization/vaccination registry of New Hampshire.

This type of document is for individuals in New Hampshire who want to choose not to participate in the state's Immunization/Vaccination Registry.

This form is used for requesting services from the Office of Family-Centered Services (BFCS) in New Hampshire.