Washington State Department of Health Forms

This form is used for authorizing the release of immunization records in the state of Washington. It allows individuals to give permission for their immunization records to be shared with designated parties.

This document is used for registering nonprofit disability-related organizations in the state of Washington.

This document is a request form used in the state of Washington to decline participation in the WAIIS (Washington Immunization Information System).

This form is used for dental professionals in Washington to apply for an endorsement to provide dental hygiene sealants and fluoride varnish treatments.

This form is used for providers to disenroll from the Childhood Vaccine Program in the state of Washington.

This form is used for active practice of midwifery in the state of Washington.

This document provides the recognition application procedures for individuals wishing to become Senior EMS Instructors in the state of Washington. It outlines the requirements and steps to follow in order to obtain this certification.

This document is for applying for a temporary worker housing license in Washington state.

This form is used for Hospital Pharmacy Associated Clinics in Washington.

This form is used for evaluating vaping-associated lung injuries in Washington.

This Form is used for conducting interviews with patients in Washington State who have experienced lung injury associated with e-cigarette use or vaping.

This form is used for licensed practical nurses in Washington who need to reactivate their expired or inactive license.

This document is for reporting cases of lung injury associated with vaping or e-cigarette use in Washington state.

This form is used for registered nurses in Washington who wish to reactivate their expired or inactive license.

This document is an application form for individuals seeking appointment as a committee member to the Department of Health (DOH) Secretary in Washington state.

This form is used for documenting training, continuing medical education (CME), and skills maintenance in the state of Washington.

This document is a sample of the EMS Course Certificate of Completion Form used in Washington state. It is used to demonstrate completion of a Emergency Medical Services (EMS) course.

This Form is used for individuals in Washington to authorize the release of WIC information.

This document is a temporary certification form for individuals in Washington who are missing proof of income. It is specifically for Russian-speaking applicants.

This document is used for reporting income for the Washington State WIC Nutrition Program in Washington. It is a form where individuals can provide a sworn statement of their income.

This form is used for temporarily certifying missing proof of income in Washington state for Oromo speakers.

This form is used for obtaining temporary certification in Washington when a person is unable to provide proof of income.

This document is a temporary certification form for individuals in Washington who are missing the proof of income form. It is available in Somali language.

This Form is used for individuals who are unable to provide proof of identity when applying for the Washington State WIC Nutrition Program. It is an Affidavit for Identity form.

This Form is used for keeping track of breastfeeding and non-breastfeeding participants in the WIC Services program in Washington state.

This form is used for completing the Infant Cascades WIC Services Worksheet in Washington state.

This document is used to track and provide services for children enrolled in the WIC program in Washington.

This document is used for the Pregnant Cascades WIC Services Worksheet in Washington state. It is a form that pregnant individuals can fill out to receive services through the WIC program.

This form is used for reporting a lost, stolen, or damaged multi-user electric breast pump in Washington.

This document is for parents in Washington state and is used as a scavenger hunt activity sheet to help them bond with their baby and learn more about them.

This form is used for soliciting client feedback for the Talk, Listen, Connect (TLC) program in Washington. The form is available in both English and Spanish.

This form is used for conducting a tlc facilitation checklist in the state of Washington. It is a document that helps ensure compliance and quality in TLC facilities.

This form is used for lodging complaints against a medical marijuana consultant in the state of Washington.