Vermont Department of Health Forms

This document provides information about the Varicella (Chickenpox) disease specifically in Vermont. It covers details such as symptoms, transmission, prevention, and treatment options.

This document is an application form used to apply for an agency license in the state of Vermont. It serves as a public notice for individuals or businesses looking to obtain a license to operate as an agency in Vermont.

This document provides instructions on how to apply for a certified copy of a Vermont birth or death certificate. It is a step-by-step guide that helps individuals navigate the application process.

This form is used for correcting or amending a Vermont birth certificate. It allows individuals to update or fix errors on their birth certificate issued in the state of Vermont.

This Form is used for consenting to parentage from assisted reproduction in the state of Vermont.

This document is used for rescinding or removing a voluntary acknowledgment or denial of parentage in Vermont.

This form is used for applying for a delayed certificate of birth in Vermont, as per 18 VSA 5075(B).

This document is used to legally deny parentage in the state of Vermont.

This document is used to request an assessment for autism in Vermont for children who may require developmental pediatric care.

This document is a legal agreement that ensures access, confidentiality, and privilege protection in the state of Vermont. It outlines the rights and responsibilities of parties involved in handling confidential information.

This Form is used for terminating the employment of a Physician Assistant in Vermont who was previously participating with a Physician.

This document is for the application to become a member of a Vermont-based organization called "You First."

This postexposure prophylaxis report form is used in Vermont for reporting cases of rabies exposure and administering necessary treatment.

This document is used to log and monitor the temperature of refrigerators and freezers in Vermont. It helps ensure food safety and compliance with regulations.

This document is used for transmitting confidential faxes related to the Vermont Perinatal Hepatitis B Prevention Program in Vermont.

This document is for parents in Vermont who do not wish to give consent for their newborn to undergo screening for certain medical conditions.

This form is used for reporting critical incidents related to substance use in the state of Vermont.

This type of document is an informed consent form used for recovery services in Vermont, as required by the Government Performance and Results Act (GPRA). It outlines the rights and responsibilities of individuals seeking recovery services and ensures that they give their informed consent for the treatment.

This form is used for amending a Vermont birth certificate to reflect an individual's gender identity. The Affidavit of Gender Identity is the document required for this process in Vermont.

This form is used for applying for a certified copy of a birth or death certificate in Vermont.

This document is used to provide additional information for obtaining a delayed birth certificate in Vermont.

This document is a grocery list specific to the state of Vermont. It may include items commonly found in Vermont grocery stores or local products.

This document is used for obtaining consent for services in the School Dental Health Program in Vermont, specifically for Tiers 1 and 2.

This document is for parents to give consent for tier 3 dental services offered through the School Dental Health Program in Vermont.

This document is a line list for influenza-like illness (ILI) cases in Vermont. It provides information about people who have symptoms similar to the flu and helps track the spread of ILI in the state.

This type of document is an agreement form for healthcare providers in Vermont who participate in the Child Vaccine Program. It outlines the terms and conditions for administering vaccines to children in the state.

This document is used for applying for certification as a drinking water laboratory in the state of Vermont. It provides the necessary forms and instructions for laboratories to meet the requirements and standards for certification.

This form is used for reporting patient choice at the end of life by physicians in Vermont.

This document is for individuals in Vermont who need a second certification from a psychiatrist. It is used to request another certification for a specific medical condition or treatment.