This is a legal form that was released by the New York State Department of Health - a government authority operating within New York.
The document is provided in Haitian Creole. As of today, no separate filing guidelines for the form are provided by the issuing department.
Form Details:
Download a printable version of Form DOH-4495A HT Supplement A by clicking the link below or browse more documents and templates provided by the New York State Department of Health.