Washington State Department of Health Forms

This Form is used for signing a confidentiality agreement in the state of Washington.

This form is used for collecting information from health professionals regarding the shortage of healthcare providers in specific areas of Washington state.

This document is a supplemental employer contact form for agency affiliated counselors in Washington state. It is used to collect additional contact information from the employer of the counselor.

This form is used for the initial and renewal application of supervisor certification for decontaminating clandestine drug labs in Washington.

This form is used for Washington WIC program to document medical information for children aged 1 to 5 years.

This form is used for Washington WIC program participants who are pregnant, breastfeeding, or non-breastfeeding. It is used to document medical information related to their eligibility and needs.

This form is used for remote dispensing sites in Washington that provide medication for opioid use disorder.

This Form is used for adding a specialty waiver to the J-1 Visa Waiver Program in the state of Washington.

This document is an addendum to the J-1 Visa Waiver Program. It specifically addresses the non-health professional shortage area (HPSA) waiver in Washington.

This document is for attesting the status of Exchange Visitors with the U.S. Department of State in Washington.

This form is used for reporting annual physician activity in the J-1 Visa Waiver Program in Washington state.

This type of document, DOH Form 346-053, is used for the Annual Employer Report of the J-1 Visa Waiver Program in Washington.

This Form is used for conducting an evaluation of internship sites in Washington.

This Form is used for reviewing collaborative drug therapy agreements in Washington State.

This Form is used for the evaluation and certification of experience for supervising pharmacists in the state of Washington.

This form is used for establishing a collaborative agreement protocol for the use of emergency contraceptive pills (ECP) in the state of Washington. It outlines the procedures and requirements for healthcare providers to administer ECP.

This Form is used for creating a collaborative agreement for immunization in Washington state.

This document is used for enrolling as a pharmacy technician-in-training in Washington state.

This Form is used to check the requirements for Canadian and foreign graduates in Washington state.

This document is used for notifying the Department of Health in Washington about the internship site and preceptor for healthcare students.

This document is used for verifying law study in the state of Washington. It is required for individuals seeking certification or licensure in the legal profession.

This Form is used for meeting the requirements checklist for Acpe Pharmacist Students in Washington state.

This form is used for evaluating and certifying work experience in order to meet certain requirements in the state of Washington.

This document is used for affidavit of an out-of-state on-the-job pharmacy technician education and training in Washington.

This document is used to verify the current active pharmacy practice in the state of Washington.

This form is used for obtaining the Director's Certification in Pharmacy Technician Education and Training in the state of Washington.

This form is used for pharmacy technicians who have completed their education and training program in a different state and want to work in Washington. The form serves as an affidavit to verify their out-of-state qualifications.

This form is used for recording measurement and bloodwork information in the state of Washington.

This type of document is used for conducting file reviews and ensuring separation of duties in Washington State.

This form is used for requesting a replacement of WIC formula in Washington.

This form is used for creating a supervisory plan in the state of Washington. It helps ensure effective management and supervision in various professional settings.

This form is used for delegating the supervision of Speech Language Pathologists in the state of Washington.

This form is used for obtaining an interim permit in the field of Speech Language Pathology or Audiology in Washington. It is necessary for supervision purposes.

This form is used for requesting professional references in the state of Washington.

This form is used for speech-language pathologists or audiologists in Washington to acknowledge their responsibility for an interim permit in the field.

This document is a checklist for dentists in Washington State when prescribing opioids for chronic pain. It helps ensure proper documentation and adherence to state regulations.

This form is used for Osteopathic Physicians and Physician Assistants in Washington State to document opioid prescribing for chronic pain. The checklist helps ensure proper documentation and adherence to regulations.

This form is used for requesting the physician disciplinary profile and Pmlexis score report for Washington. It provides information about a physician's disciplinary record and their score on the Pmlexis exam.