New York State Department of Health Forms

This document is a checklist for testing, operation, and maintenance of residential wells in New York. It helps ensure the proper functioning and safety of individual water supply wells.

This Form is used for attesting compliance with an automated dispensing system in the state of New York.

This form is used for designating a health care proxy in New York, written in Chinese Simplified. It allows individuals to appoint someone to make medical decisions on their behalf if they are unable to do so themselves.

This Form is used for requesting an assessment related to spousal impoverishment in the state of New York.

This document is a screening and consent form for the Jynneos vaccine in New York. It is used to gather information and obtain consent from individuals before administering the vaccine.

This form is used to provide information on available options for applicants who may be blind or visually impaired in New York. It is available in French.

This form is used for applicants in New York who may be blind or visually impaired to inform them of their options.

This form is used for requesting a limited medication drop box for institutions in New York. It is known as Form DOH-5788 Institutional Dispenser.

This document is used for designating a health care proxy in New York. It is available in Italian.

This document is used to designate a health care proxy in New York. The form is available in French.

This document is used for designating a health care proxy in New York, specifically for individuals who prefer to use the Yiddish language.

This type of document is used for designating a health care proxy in New York. It is available in Urdu language.

This document is used for designating a health care proxy in New York for individuals who prefer to use the Bengali language.

This form allows individuals in New York to designate a health care proxy in Arabic. It is used to ensure that their medical decisions are made according to their wishes if they become unable to communicate or make decisions themselves.

This document provides the recommended schedule for childhood and adolescent immunizations in the state of New York. It outlines the specific vaccines that children and teenagers should receive at different ages to protect against various diseases.

This document provides a detailed calendar for adult immunization treatments in New York. It provides guidance on when specific vaccines should be administered and includes updates on new vaccine recommendations.

This document provides a to-do list for school nurses in New York. It includes tasks and responsibilities they need to complete.