New Hampshire Department of Health and Human Services Forms

This form is used for requesting non-confidential data in the state of New Hampshire. It allows individuals to obtain specific information that is not considered confidential.

This document is for individuals in New Hampshire who are applying to become caregivers for the therapeutic use of cannabis. It outlines the application process and requirements for caregivers.

This document is a guide for caregivers in New Hampshire who are seeking child protection services. It is in Spanish.

This Form is used for tracking the formulas that have been returned, donated, or destroyed in the state of New Hampshire.

This form is used for Medicaid recipients in New Hampshire to request reimbursement of co-pays for mail order drugs.

This document is a registration form for the NH Mmis Health Enterprise Portal in New Hampshire. It is used for individuals or organizations to register for access to the portal.

This form is used for reporting Covid-19 cases in the state of New Hampshire. It collects essential information about individuals who have tested positive for the virus.

This document is for withdrawing a written certification from the Therapeutic Cannabis Program in New Hampshire.

This document is an agreement specific to New Hampshire that outlines the terms and conditions for refunding insurance premiums. It governs the process of returning money to policyholders when they are entitled to a refund.

This Form is used for requesting continued use of confidential data in the state of New Hampshire.

This form is used for providing a guide to caregivers regarding Child Protective Services in New Hampshire. It helps caregivers understand the processes and resources available to assist them in ensuring the safety and well-being of children under their care.

This Form is used for withdrawing and removing information from the New Hampshire Immunization/Vaccination Registry in French.

This document is a request for a waiver of reporting requirements for the New Hampshire Prescription Drug Monitoring Program. The waiver is for the purpose of exempting certain individuals or organizations from the obligation to report prescription drug information to the program.

This form is used for applying as a lead abatement contractor in New Hampshire.

This type of document is the medication administration curriculum for Section II in the state of New Hampshire.

This document is used for applying for a health facility license in the state of New Hampshire, whether it is an initial application or a renewal.

This form is used for filing a complaint related to the Indoor Smoking Act in New Hampshire.

This document is used for reporting foster parent training in New Hampshire.

This form is used for requesting respite care services in New Hampshire.

This form is used for the annual request to remove a property from the residential rental market in New Hampshire.

This document is for applying for financial assistance in New Hampshire.

This Form is used for evaluating the mobility needs of individuals using wheelchairs in the Fee-For-Service (FFS) Program in New Hampshire. It is not intended for use in Managed Care programs.

This type of document, "Certificate of Religious Exemption - New Hampshire," is used for individuals seeking an exemption from certain religious requirements in the state of New Hampshire.

This document is used for the self-evaluation of the competency of the local agency Vena/Gthm in New Hampshire.

This form is used for requesting an extension of time for filing taxes in the state of New Hampshire.

This form is used for requesting consent for behavioral health and narcotic medication in the state of New Hampshire.

This document is used for reporting an eye examination and authorizing the release of medical information in New Hampshire.

This document is a form used for determining the eligibility of individuals for non-emergency medical transportation under Medicaid plans in New Hampshire. It helps in determining if someone qualifies for transportation services to and from medical appointments.

This document provides a request for a standard formula for infants aged 6 to 12 months who are not receiving WIC foods. It is specific to the New Hampshire WIC Nutrition Program.

This document provides information about the amount of sugar consumption and may reveal surprising facts.

This Form is used for reporting confidential information of providers related to Hepatitis C in New Hampshire.

This form is used for allowing the New Hampshire Department of Health and Human Services to disclose protected patient records to a third-party entity without a lawful data privacy framework.

This form is used for reporting changes in the Snap Program benefits in New Hampshire.

This document is an activity worksheet for the New Hampshire Breastfeeding Peer Counseling Program. It provides activities related to breastfeeding support and education.

This document is for parents in New Hampshire who do not wish to give their consent for their newborn to undergo repeat newborn screening.