Vermont Department of Health Forms

This form is used for reporting and documenting any downtime or issues with the EMS sirens in Vermont.

This document is used to declare the homeless status of an individual in the state of Vermont. It can be used as proof for accessing certain social services and benefits.

This document is an agreement for healthcare providers participating in the Vermont Adult Vaccine Program. It outlines the terms and conditions for providing vaccines to eligible adults in Vermont.

This document is for medical providers in Vermont and it is called the Vermont Immunization Registry Access and Confidentiality/Privilege Agreement. It outlines the agreement and the responsibilities regarding the access and confidentiality of the immunization registry.

This Form is used for screening the functional abilities of children aged 24-36 months in Vermont for personal care services.

This document outlines the personalized care plan for children receiving personal care services in Vermont. It includes details about the specific needs and services required for each child.

This document is a form used by the Town Health Officer in Vermont for reporting animal bites.

This document is a release form for the Impaired Driver Rehabilitation Program in Vermont. It allows individuals to give consent for the program to release their confidential information. The form is available in both English and Spanish.

This document provides information about the treatment requirements for reinstating a driver's license after participating in the Impaired Driver Rehabilitation Program (IDRP) in Vermont. It is available in both English and Spanish.

This document provides evaluation information about the Vermont Impaired Driver Rehabilitation Program. It is available in both English and Spanish.

This document is a refusal form for parents in Vermont who do not consent to newborn screening for their baby.

This Form is used for parents in Vermont who want to refuse consent for newborn screening.

This document is for parents in Vermont who want to refuse consent for newborn screening for their baby. It is available in Nepali language.

This type of document is a rejection of consent for newborn screening in the state of Vermont.

This document is for parents in Vermont who wish to refuse newborn screening for their child. It provides a formal way to express their decision.

This document is for parents in Vermont who are refusing to give their consent to repeat newborn screening for their baby.

This document is used to request the destruction of a newborn filter paper specimen in Vermont. It includes the necessary documentation for proper disposal.

This Form is used for refusing the consent to repeat the newborn screening exam in Vermont, written in Spanish.

This Form is used for parents in Vermont who refuse to allow their newborn to undergo screening tests.

This form is used for refusing to give consent for repeat newborn screening in the state of Vermont.

This form is used for obtaining permission to release and disclose developmental screening results in the state of Vermont.

This document is used for applicants in Vermont to provide a statement regarding child support and taxes.

This Form is used for applying for a lead contractor license in Vermont.

This form is used for individuals who are applying for asbestos licensure in the state of Vermont.

This document notifies individuals about the demolition process and the regulations regarding asbestos and lead in Vermont. It provides important information about the requirements and procedures that need to be followed during demolition.

This document is used for individuals in Vermont to apply for a licensure for lead-related work.

This form is used for applying for a license for entities involved in asbestos-related activities in Vermont.

This Form is used for notifying the authorities in Vermont about a planned demolition. It provides instructions on the process and requirements for notifying the appropriate agencies about the demolition project.

This Form is used for applying for an asbestos abatement project permit in Vermont.

This form is used for applying for a permit to conduct a lead abatement project in Vermont.

This document is a referral form used in Vermont for children with special health needs who require nutrition services.

This form is used for reporting outbreaks of Norovirus-like illness in Vermont.

This document is a referral form for the Pediatric High-Tech Nursing Program in Vermont. It is used to refer children who require specialized nursing care to the program.

This form is used for reporting outbreaks of influenza-like illness in the state of Vermont. It helps track the spread of the illness and take necessary measures to prevent further transmission.

This document is a questionnaire for lead health education teachers in Vermont, as part of the School Health Profiles program. It collects information about health education practices in schools.