North Dakota Department of Health and Human Services Forms

This document is used for recording the results of smoke detector testing in North Dakota.

This document is used for transferring a patient from a swing bed to a hospital in North Dakota.

This document is used for informing patients in North Dakota about the transfer or discharge from a swing bed facility due to nonpayment.

This document is used to notify the transfer or discharge of an individual in a healthcare facility in North Dakota. It is important for ensuring proper documentation and communication of such changes.

This form is used for notifying the transfer of a patient to another hospital for hospitalization in the state of North Dakota.

This Form is used for applying for approval for a Nurse Aide Training Program in North Dakota.

This form is used for requesting a waiver of a licensing rule or construction standard in North Dakota. It allows individuals or businesses to seek an exemption from certain requirements.

This Form is used for collecting demographic information from women in North Dakota. It is available in Spanish.

This document is a review of the plan of correction for the Life Safety Code in North Dakota. It ensures that necessary safety measures are in place for buildings and facilities.

This form is used for requesting Women's Way materials in North Dakota.

This form is used for applying for Medicaid under the Women's Way program in North Dakota. It is specifically designed for women who are seeking healthcare services related to breast or cervical cancer.

This form is used for documenting the completion of treatment in the state of North Dakota. It serves as an official record indicating that an individual has completed a specific course of treatment or therapy.

This document is a legal agreement used in North Dakota for the appointment of an Emergency Medical Services (EMS) Medical Director. It outlines the responsibilities, duties, and compensation for the medical director in the field of emergency medical services in North Dakota.

This document is an agreement form used by EMS squads in North Dakota to establish the roles and responsibilities of a squad leader.

This form is used for documenting patient care provided by EMS providers in North Dakota. It includes important information such as patient demographics, medical history, and treatment provided.

This Form is used for reporting continuing education for non-nationally registered Emergency Medical Responders, Ambulance First Aid Attendants, and Emergency Medical Technicians in North Dakota.

This Form is used for applying for a license from the Quick Response Unit in North Dakota.

This form is used for registering for emergency medical services (EMS) in North Dakota specifically for the Covid-19 pandemic.

This form is used for individuals or organizations in North Dakota to apply for a provider license related to Covid-19.

This Form is used for applying or renewing a provider license in North Dakota.

This form is used for EMS courses in North Dakota. It includes a roster of course participants and requires physician authorization.