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STATE OF LOUISIANA 143 Rev 05/2017LOUISIANA DEPARTMENT OF HEALTH OFFICE OF BEHAVIORAL HEALTHPhysicians Certificate for a Minor (Complete within 72 hours of voluntary admission) For observation, diagnosis,

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Step 9: Sign and date the form at the designated space.

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Step 10: Submit the filled-out form along with any required fees or supporting documents to the Louisiana Department of Health.

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Individuals seeking healthcare services in the state of Louisiana.

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What is louisiana department of health?

The Louisiana Department of Health is the state agency responsible for protecting and promoting the health of the residents of Louisiana.

Who is required to file louisiana department of health?

Certain healthcare facilities, providers, and professionals in Louisiana are required to file with the Department of Health.

How to fill out louisiana department of health?

To fill out the Louisiana Department of Health forms, one must gather all necessary information and follow the instructions provided on the forms.

What is the purpose of louisiana department of health?

The purpose of the Louisiana Department of Health is to ensure the health and well-being of the people of Louisiana by regulating healthcare providers and facilities.

What information must be reported on louisiana department of health?

Information such as patient data, healthcare services provided, and financial information may need to be reported on the Louisiana Department of Health forms.

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