New York State Department of Health Forms

This form is used for acknowledging the rules and regulations of tanning facilities in New York.

This document is used for designating a person to make medical decisions on your behalf in the event that you are unable to do so. It is specific to the state of New York.

This form is used for reporting on the operation of a swimming pool in New York. It is important for maintaining the safety and cleanliness of public swimming pools.

This is a legal document signed by a patient that gives consent to the release of health information within the state of New York.

This form can be used by individuals who would like to apply for certain types of assistance in the state of New York, such as home care, help with skilled or personal tasks, housekeeping, etc.

This form is used for authorizing the release of health information in accordance with HIPAA regulations in the state of New York.

This form is used for birth parents in New York to register in the Adoption Information Registry.

This form is used for applying to the local registrar in New York to obtain a copy of a birth record.

This form is used for applying for AEMT Rapid Recertification in the state of New York.

This document is a form used to record the results of a rapid HIV antibody test in New York. It is used to document whether the test was positive or negative for HIV antibodies.

This form is used for reporting on the test and maintenance of backflow prevention devices in New York. It ensures that these devices are functioning properly to prevent the contamination of drinking water.

This form is used for making a medical referral for infants and children participating in the WIC program in New York.

This is one of the documents you need to fill out when applying for Public Health Insurance Programs in the state of New York.

This form is used for summarizing methadone usage in the state of New York. It provides a report on the use of methadone for the treatment of opioid addiction.

This form is used for birth parents in New York to register with the Adoption Information Registry for the purpose of reuniting with their adopted child.

This form is used for reporting exemptions for emergency pesticide application notifications in New York. It allows individuals to notify the Department of Health about emergency pesticide applications that are exempt from the usual notification requirements.

This form is used for applying for the Adap Plus Insurance Continuation (Apic) program in New York. It is designed to help eligible individuals continue their insurance coverage.

This form is used for applying by mail to obtain a copy of a marriage certificate in New York.

This is a form used by the residents of New York to request a specific mode of transportation which is necessary because they are unable to use public transportation to go to school, places of worship, stores, etc.

This form is used for applying to the Medicare Savings Program in New York.

This form is used for reporting an adoption in the state of New York. It must be completed and submitted to the Department of Health.

This form is used for authorizing the release of health information, including confidential HIV-related information, in the state of New York.

This form is used for authorizing the release of information, including alcohol/drug treatment and mental health information, as well as confidential HIV/AIDS-related information in New York.

This document is for ordering publications from New York's catalog.

This form is used for applying for health insurance in New York.

This form is used for Supplement A Access NY program in New York. It provides additional information for individuals applying for benefits.

This Form is used for stating and certifying a Health Home in the state of New York.

This form is used for registering for the Opioid Overdose Prevention Program in New York.

This document is used for conducting patient reviews in hospitals and communities in New York.

This Form is used for screening purposes in New York.

This form is used for adding additional information to a home care application in New York.

This form is used for certifying and planning home health care services in New York.

This document is used for requesting prior approval for home care durable medical equipment (DME) in New York.

This form is used for filing a complaint related to violations of the Americans with Disabilities Act (ADA) in the state of New York.

This form is used for applying for equivalency or reciprocity for asbestos safety training in the state of New York.