Washington State Department of Health Forms

This document is a reporting form used in Washington state for reporting cases of Poliomyelitis/Acute Flaccid Myelitis (AFM).

This form is used for reporting rare diseases of public health importance in the state of Washington.

This form is used for reporting cases of Rubella in the state of Washington. It is required to be filled out by healthcare providers and submitted to the Department of Health.

This form is used for reporting incidents of shellfish poisoning in the state of Washington.

This form is used for reporting cases of shigellosis, a contagious bacterial infection, in Washington state.

This Form is used for reporting cases of salmonellosis in Washington state. It helps health authorities track and investigate outbreaks of this bacterial infection.

This form is used for reporting cases of Coccidioidomycosis in Washington state.

This document is a Tetanus Reporting Form used in the state of Washington. It is used for reporting cases of tetanus to the Department of Health.

This Form is used for reporting cases of tularemia in the state of Washington. It helps monitor and track the spread of this infectious disease.

This document is for reporting cases of typhoid fever in Washington state.

This form is used for reporting outbreaks of diseases or illnesses that are not specifically listed on the Washington State Department of Health's standard outbreak reporting forms.

This form is used for reporting cases of Trichinosis in the state of Washington.

This form is used for reporting the transmission of the Vaccinia virus in the state of Washington.

This form is used for reporting cases of Q fever in Washington state.

This document is used for reporting unexplained critical illness or death in Washington state.

This form is used for reporting Varicella (chickenpox) related deaths in the state of Washington.

This Form is used for reporting cases of West Nile Virus Disease in Washington state.

This Form is used for investigating waterborne disease cases in Washington state.

This document is used for reporting non-cholera vibriosis cases in Washington state.

This form is used for reporting cases of yellow fever in Washington.

This form is used for reporting cases of Yersiniosis in the state of Washington.

This form is used for activating an expired license for nursing home administrators in Washington state.

This form is used for nursing home administrators in Washington to attest their completion of continuing education requirements.

This form is used for reporting cases of Shiga Toxin-Producing Escherichia Coli (STEC) in the state of Washington. It helps track and monitor the spread of this bacterial infection.

This Form is used for providing feedback on the certifier competency training in the Washington State WIC Nutrition Program.

This document is used for certifier competency training documentation in the Washington State WIC Nutrition Program.

This form is used for keeping a record of group training sessions conducted as part of the Washington State WIC Nutrition Program.

This form is used for applying for a nursing home administrator license in Washington state.

This Form is used for applying for an Ambulatory Surgical Facility License in Washington state. It is required for facilities that provide same-day surgical procedures.

This type of document is used to apply for a license for a birthing or childbirth center in Washington state.

This Form is used for keeping track of individual training in the Washington State WIC Nutrition Program.

This document is used for verifying the training of a qualified provider in electroneuromyography in the state of Washington.

This Form is used for reporting and tracking continuing education requirements for physical therapists and physical therapy assistants in Washington state.

This form is used for requesting a spinal manipulation endorsement in Washington.

This form is used for physical therapy employment verification in the state of Washington.

This form is used for the verification of mentored sharp debridement education and training in the state of Washington.

This document provides a roadmap for families in Washington to learn about hearing loss and its implications. It is used to guide families in understanding the support and resources available for individuals with hearing loss.

This document is used for verifying the employment or student status of agency affiliated counselors in the state of Washington.