New York State Department of Health Forms

This type of document is used for ordering brochures in New York.

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

This form is used for authorizing the release of health information and confidential HIV related information in New York for Chinese speakers.

This document is for authorizing the release of health information and confidential HIV related information in New York, written in Haitian Creole.

This Form is used for filing a complaint report if you believe there has been a violation of Article 27f in New York.

This form is used for reporting complaints regarding alleged violations of Article 27f in New York specifically for the Chinese-speaking community.

This form is used for reporting complaints regarding alleged violations of Article 27f in New York. It is available in Haitian Creole language.

This Form is used for filing a complaint regarding an alleged violation of Article 27f in the Korean language in New York.

This form is used to acknowledge paternity for a child born to an unmarried woman in New York.

This form is used for notifying the cancellation of a course in New York.

This form is used for authorized Registered Physician Assistants in New York State to prescribe medications.

This form is used for applying for instructor certification in New York.

This form is used for reporting the daily operations of beaches in New York. It helps to monitor and manage the activities and conditions of the beaches.

This form is used for notifying the New York Department of Health about a pharmacist's failure to provide an official prescription from a practitioner.

This form is used for reporting the loss or theft of official New York State prescriptions.

This form is used for changing the Tpa/Aso status in the state of New York.

This form is used for filing a merger or acquisition in the state of New York.

This form is used for changing payor, TPA (Third Party Administrator), or ASO (Administrative Services Only) information in the state of New York.

This form is used for applying to be a payor under New York State law. It allows individuals or organizations to request approval to make insurance payments on behalf of injured persons.

This form is used for applying for a new Electronic Filing User ID in New York.

This document provides a report of the payments made for the medical assistance surcharge by non-electing providers in New York.

This form is used for adding new clients to the TPA/ASO client list in New York.

This form is used for providers in New York to request a change of their name or address.

This form is used for making additions or deletions to the TPA/ASO client list in New York.

This form is used for updating the payor filing status in New York.

This form is used for applying for TPA/ASO election in New York.

This Form is used for reporting the end of month covered lives enrollment option for payors in New York.

This Form is used for providers in New York to elect Medicaid withholding for their services.

This form is used for changing the payor status in New York.

This Form is used for disclosing information about an individual's character and competency for a review process in New York.

This form is used for tracking internships in the New York State Department of Health (DOH). It helps maintain a record of internships and monitor the progress of interns.

This Form is used for reporting and documenting medical incidents that occur in New York state. It is specifically designed for public functions and serves as a log for tracking these incidents.

This document is used for creating a swimming pool safety plan in New York. It includes guidelines and requirements for ensuring the safety of pools.

This form is used for obtaining general information and applying for genealogical services in New York.

This form is used for EMS agencies in New York to apply for and receive approval for using Electronic Patient Care Reporting (e-PCR) system.