North Dakota Department of Health and Human Services Forms

This form is used for EMS registration in North Dakota. It is a document that must be completed by individuals or organizations seeking to provide emergency medical services in the state.

This form is used for requesting access to or copies of protected health information in North Dakota.

This document provides checklists and attestation forms for the application process of targeted case management in North Dakota.

This Form is used for requesting to add an affiliation in the state of North Dakota.

This form is used for certifiers in North Dakota to assist in completing a Medical Certification of Death. It serves as a worksheet to help gather the necessary information for certifying a death.

This document is used for applying for classification as inundated agricultural land in North Dakota. It helps individuals or businesses who have land that is frequently flooded to obtain the appropriate classification for agricultural purposes.

This form is used for applying for an exemption of solar, wind, or geothermal devices in North Dakota.

This form is used for applying for a property tax exemption for improvements made to commercial and residential buildings in North Dakota.

This form is used for applying for property tax exemption in the state of North Dakota.

This document is a tuberculosis risk assessment form specifically designed for adults in North Dakota. It helps individuals and healthcare professionals evaluate the risk of tuberculosis infection and determine appropriate preventive measures.

This document is used to request a referral consultation in North Dakota. It helps facilitate communication between healthcare providers regarding the need for a specialist consultation.

This form is used for documenting medical information for participants in the WIC program in North Dakota.

This form is used for reporting missing Universal Product Code (UPC) information in North Dakota.

This form is used to apply for licensure as a Certified Professional in Food Safety in North Dakota.

This form is used for verifying the diagnosis and Medicaid referral in North Dakota.

This form is used for requesting a test in the state of North Dakota.

This document is used for the attestation of Electronic Plan of Correction (Epoc) Training in North Dakota.

This document is a shelter triage form used in the state of North Dakota for assessing and prioritizing individuals seeking shelter.

This document outlines the general requirements for accepting patients or residents beyond the capacity of a facility's license or certification in North Dakota. It also covers the guidelines for accepting patients into beds that are licensed or certified for a different provider type.