Washington State Department of Health Forms

This form is used for a pre-inspection self-assessment checklist specifically for moderate complexity chemistry tests in the state of Washington. It helps laboratories ensure that they are meeting the necessary requirements for conducting these types of tests.

This document is a pre-inspection self-assessment checklist specifically designed for moderate complexity hematology/coagulation laboratories in the state of Washington. It helps ensure that the laboratory meets the required standards and regulations prior to an inspection.

This type of document is a pre-inspection self-assessment checklist for moderate complexity microscopic examinations in Washington. It is used to ensure that all necessary requirements are met before conducting the inspections.

This document is a checklist for individuals in Washington to assess the readiness of testing kits with moderate complexity before conducting inspections.

This form is used for registering the location of Automated Drug Dispensing Devices (ADDD) in Washington state. ADDDs are used to dispense medication automatically, and this form ensures proper tracking and regulation of these devices.

This document is a customer satisfaction survey form used in Washington. It is used to gather feedback from customers regarding their experience with a service or organization.

This form is used for applying for a pharmacy remodel in the state of Washington.

This document provides a checklist and review sheet for emergency drug anaphylactic reaction kits for non-hospitalized patients in Washington. It helps ensure that these kits are well-prepared and equipped to handle allergic reactions.

This form is used for requesting an alternative temperature display for the Washington State Childhood Vaccine Program.

This document is used for requesting off-site backup thermometers for the Childhood Vaccine Program in Washington.

This Form is used for creating a plan of correction for a nursing assistant program in Washington state.

This form is used for applying for the Pharmacy Ancillary Utilization program in Washington.

This document is a survey tool used by the Department of Health in Washington for reviewing the records of personnel, contractors, and volunteer personnel involved in home care services.

This document is used for reviewing the client records of home care services in Washington.

This Form is used for recording personnel information related to home health services in Washington state. It is used to assess the qualifications and records of personnel, including contractors and volunteers, involved in providing home health care.

This form is used for conducting a state record review of hospice facilities in the state of Washington. It is used to ensure compliance with regulations and standards for providing hospice care.

This form is used for conducting a personnel survey of hospice and hospice care center personnel in Washington. It helps in reviewing the personnel records of personnel, contractors, and volunteer personnel.

This type of document is used for applying for certification as a training provider for decontaminating clandestine drug laboratories in Washington state.

This form is used for gathering information about a person's family history of cancer. It is specifically for residents of Washington state.

This Form is used for reporting vaccine losses in the Adult Vaccine Program in Washington.

This Form is used for transferring vaccines within the Adult Vaccine Program in Washington state.

This form is used for ordering a birth certificate by mail in Washington state.

This document is a mail order form for requesting a death certificate in Washington state.

This form is used to request death certificates by mail in Washington state.

This type of document is for applying to the Emergency Medical Services Ongoing Training & Evaluation Program in Washington state. It is used to assess and track ongoing training and evaluation for EMS providers.

This form is used for collecting demographic information from osteopathic physicians in Washington state. It is used for attestation purposes.

This form is used for obtaining a license certification for volunteer and retired healthcare providers in the state of Washington.

This type of document is used for conducting a survey on the water quality of shellfish in Washington state. It is specifically for assessing the presence of bacteria in shellfish habitats.

This form is used for conducting a survey to assess the bacteriology water quality in re-circulating water systems that involve shellfish in the state of Washington.

This form is used for tracking the chain of custody for lead and copper testing in Washington state.

This form is used for the transfer of sponsoring veterinarian in Washington for veterinary medication clerk registration.

This document is used for training veterinarians in the state of Washington. It is an affidavit relating to their training.

This Form is used for providing customers access to employee restrooms in Washington state.

This document is a form used in Washington State for sharing immunization data. It is for use with the Washington State Immunization Information System.

This type of document is an Information Sharing Agreement used in Washington State for exchanging immunization data through the Washington State Immunization Information System.

This form is used for notifying changes in administrators for behavioral health agency service providers in Washington state.