New Hampshire Department of Health and Human Services Forms

This Form is used for the disposition or change of ownership of a radiation or MRI machine in New Hampshire.

This form is used for verifying health care provider diagnoses and is specifically for partners in health in New Hampshire.

This document is a BFA Formulario 778 Declaracion Del Representante Autorizado (Ra) in Spanish for the state of New Hampshire. It is used for declaring an authorized representative.

This Form is used for submitting a six-month nurse trainer report to the NH Bureau of Developmental Services Medication Committee.

This form is used for documenting the training and experience of a Radiation Safety Officer in New Hampshire. It also includes a section for attestation by a preceptor.

This form is used for reporting cases of sexually transmitted infections (STIs) in New Hampshire.

This Form is used for authorized users in New Hampshire to document their training and experience in diagnostic radiology, as well as the attestation of their preceptor.

This document is used for the referral of children and adolescents to Hampstead Hospital in New Hampshire.

This document is for the authorized users of the Special Medical Services (Sms) Application in New Hampshire. It outlines the agreement regarding the use of this application for accessing special medical services.

This document is a short form of the SNAP-IV questionnaire, which is used in New Hampshire. It is used to assess symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents.

This document is a sample order form for a septic system in the state of New Hampshire. It can be used as a guide for placing an order for the installation or maintenance of a septic system.

This form is used for registering as a provider of radiation or MRI machine-related services in New Hampshire.

This form is used for requesting a waiver to HE-M 520 (SMS) or HE-M 523 (PIH) in New Hampshire.

This form is used for renewing payment certification for foster care programs in New Hampshire.

This Form is used for registering beverages and bottled water in the state of New Hampshire.

This document provides information and forms for individuals seeking certification in New Hampshire for residential purposes. It includes details about the certification process and the required documentation.

This form is used for obtaining a waiver for carrying the He-M Epinephrine Auto-injector in the state of New Hampshire.

This document is an agreement that outlines the terms and conditions for using breastfeeding equipment in the state of New Hampshire.

This document is used for requesting an amendment of health information at Hampstead Hospital in New Hampshire.

This document is used for getting to know school-aged children (4-10 years old) in New Hampshire.

This type of document is a statewide form in New Hampshire that is used for conducting a "one-touch" healthy homes checkup.

This form is used for registering cancer cases in the state of New Hampshire. It is part of the public health effort to track and monitor cancer incidence in the state.

This form is used for gathering information about a child or youth in the state of New Hampshire. It may be used for various purposes such as enrollment in school, camps, or childcare programs.

This Form is used for youth aged 11-18 in New Hampshire to provide personal information and details about themselves.

This document provides information on the certification process for Behavioral Health professionals in the state of New Hampshire. It includes details on the requirements, application process, and resources available for individuals seeking certification in this field.

This document is used for recording the vaccination history of individuals for Hepatitis A in the state of New Hampshire.

This Form is used for quarterly reporting for the New Hampshire Syringe Services Program in New Hampshire.

This Form is used for providing minimal information about a child/youth in New Hampshire.

This form is used for the voluntary placement agreement for the Hope Program in New Hampshire.

This Form is used for the authorized user agreement for the Partners in Health (PIH) application in New Hampshire.

This Form is used for applying or renewing a lead license or certification in the state of New Hampshire.

This document is a Substance Abuse Intake Questionnaire specifically designed for residents of New Hampshire. It is used to gather important information about individuals seeking substance abuse treatment in the state.

This document is for applying for a license to become a lead training provider in the state of New Hampshire.

This form is used for obtaining a Certificate of Lead Safe in New Hampshire. It is necessary for confirming that a property is safe from lead hazards.

This Form is used for reporting infant information as part of the Perinatal Hepatitis B Prevention Program in New Hampshire.

This form is used for providing medical information in the state of New Hampshire.

This document is used to notify individuals or organizations of the termination of their use of confidential cancer data in the state of New Hampshire.

This document is for caregivers participating in the Therapeutic Cannabis Program in New Hampshire. It is used to attest that the caregiver does not have any felony convictions.

This document provides information on the certification process for child protective services (CPS) in the state of New Hampshire. It includes details about the requirements, application process, and what to expect during the certification process.

This form is used for requesting to determine presumptive eligibility for healthcare coverage in New Hampshire.