North Dakota Department of Health and Human Services Forms

This consent form is used in North Dakota for applying fluoride varnish to protect teeth from cavities.

This document outlines the HACCP (Hazard Analysis and Critical Control Point) plan specific to food safety in North Dakota.

This form is used for applying for a beverage license in North Dakota.

This form is used for obtaining approval for a four-year old program in North Dakota.

This Form is used for claiming an exemption from immunization requirements in North Dakota.

This form is used for applying for a temporary food service establishment license in North Dakota.

This form is used for applying for a food establishment license in North Dakota.

This document is used for authenticating user access to the Evers Vital Records Unit in North Dakota for hospital birth records.

This Form is used for authenticating users at Evers Vital Records Unit - North Dakota for funeral home purposes.

This Form is used for reporting suspected fraud in North Dakota.

This form is used for providing ownership and controlling interest information as well as conviction information in North Dakota.

This document is a care coordination request report specific to North Dakota in the year 1915. It provides information and requests for coordinated care services in the state.

This document is for the review of Home and Community Based settings in North Dakota that require heightened scrutiny under Section 1915(I) of the Medicaid program. It outlines the process for on-site visits and evaluations to ensure compliance with the program's standards.

This document is used for obtaining signatures of attendees at a meeting in North Dakota. It helps verify the presence of individuals and their agreement with the topics discussed or decisions made during the meeting.

This type of document is used for creating a community transition plan of care and requesting funds in North Dakota in 1915(I).

This document is used for obtaining individual acknowledgements and signatures for care coordination in the state of North Dakota.

This document is a form used in North Dakota to document an individual's rights and responsibilities.

This document is used to request a service provider in North Dakota in the year 1915.

This type of document provides guidelines and information on how to ensure compliance with social distancing measures in the community of North Dakota. It includes recommendations for individuals and businesses to help prevent the spread of COVID-19.

This document is for tracking the daily temperature of individuals in isolation or quarantine at home in North Dakota.

This document is a Home Isolation/Quarantine Assessment Tool specific to the state of North Dakota. It is used to assess whether individuals should be subject to home isolation or quarantine measures during the COVID-19 pandemic.

This document outlines the scoring system used to evaluate the sheltering-in-place capacity of health care facilities in North Dakota.

This document is a draft survey that assesses the vulnerability of hospitals and their capacity to provide shelter-in-place in North Dakota. It aims to gather information on the preparedness of hospitals in case of emergencies or disasters.

This document provides guidance on how to handle medication provision during a disaster in North Dakota. It includes strategies for ensuring access to necessary medications, coordinating with healthcare providers, and prioritizing distribution to affected individuals.