Indiana State Department of Health Forms

This form is used for reporting animal bites in the state of Indiana. It is the official document to record information about the incident and the animals involved.

This form is used for documenting the medical history of a child who is being adopted in the state of Indiana. It provides important medical information for the adoptive family and helps ensure the child receives proper care.

This form is used for dads in Indiana to register themselves as putative fathers.

This Form is used for virology purposes in the state of Indiana. It is specifically designated as State Form 35212.

This document is used for completing a Certificate of Live Birth in the state of Indiana. It provides a worksheet format to gather necessary information for the birth certificate.

This form is used for reporting confidential information regarding communicable diseases in Indiana.

This Form is used for reporting rabies post-exposure treatment in Indiana.

This form is used for investigating cases of tularemia in the state of Indiana.

This Form is used for investigating anthrax cases in Indiana.

This Form is used for applying and claiming biologicals in the state of Indiana.

This Form is used for documenting the official record of adoption in the state of Indiana. It includes information about the adoptive parents, birth parents, and the adopted child.

This Form is used for investigating cases of Cryptococcosis in the state of Indiana.

This Form is used for reporting cases of Lyme Disease in the state of Indiana.

This form is used for ordering a water test kit in the state of Indiana.

This form is used for applying for initial licensure or renewal of licensure as a professional matchmaker in Indiana.

This form is used for investigating leptospirosis cases in the state of Indiana.

This document is used for conducting an investigation on a severe Staphylococcus aureus infection in a previously healthy person in Indiana.

This form is used for documenting the summary and conducting contact investigations for Tuberculosis cases in Indiana.

This form is used for recording the HIV test history and assessment of pregnant women in the state of Indiana.

This form is used for conducting a case investigation of Hepatitis C in Indiana. It helps collect important information about the virus, its transmission, and the individuals affected.

This Form is used for requesting a waiver for tuberculosis testing in the state of Indiana.

This Form is used for recording vaccine administration for children and teens in Indiana.

This Form is used for conducting a Varicella (Chickenpox) Case Investigation in the state of Indiana. It helps health officials gather important information about individuals diagnosed with chickenpox to monitor outbreaks and prevent further transmission.

This form is used for investigating cases of perinatal hepatitis B in Indiana.

This form is used for applying for a proficiency certification for limited radiographer in the state of Indiana.

This Form is used for maintaining the confidentiality of information related to the Indiana Division of Hearings and Appeals (IDHA) and the Indiana Bureau of Rehabilitation Services (IBRS).

This form is used for the Indiana Adoption Medical History Registry in the state of Indiana. It allows individuals involved in the adoption process to provide medical history information.

This form is used for applying for approval of a radiology program in the state of Indiana. It is required for individuals or institutions seeking to offer radiology educational programs.

This Form is used for providing consent to share identifying information in the Indiana Adoption Matching Registry.

This Form is used for removing user access from the Indiana Birth/Death Registration System (IBRS) or (IDRS) in Indiana.

This form is used for making changes to a birth record in Indiana, such as establishing paternity or making other necessary amendments.

This Form is used to establish paternity for a child who is less than sixty (60) days old in Indiana through the local health department.

This Form is used to apply for health coverage in the state of Indiana.

This Form is used for reporting incidents of exposure to blood or body fluids in the state of Indiana. It is important for healthcare professionals to notify the appropriate authorities to ensure proper follow-up and prevention of potential infections.