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Division of Public Health Agreement Addendum FY 2021-Page 1 of 22 Master Local Health Department Legal NameWomens and Children's Health Section / Women's Health Branch DPH Section / Branch Name101
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01
Start by downloading the DHHS DPH WHB Agreement form from the Department of Health and Human Services website.
02
Read through the agreement form carefully to understand the terms and conditions.
03
Fill in the required information in the relevant fields, such as the names of the parties involved, contact information, and any specific details mentioned in the agreement.
04
Ensure to provide accurate and up-to-date information.
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Review the filled-out form to ensure all necessary sections are completed.
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Sign the agreement form, along with any other required signatures from the other parties involved.
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Make copies of the filled-out and signed agreement form for your records.
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Submit the agreement form as per the instructions provided, whether it is by mail, email, or through an online portal.
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Keep a copy of the submission confirmation for future reference.

Who needs dhhs dph whb agreement?

01
Anyone who is involved in a contract or agreement with the Department of Health and Human Services (DHHS) and the Department of Public Health (DPH) related to the Women's Health Branch (WHB) may need to fill out the DHHS DPH WHB Agreement.
02
This can include healthcare providers, organizations, researchers, or any other party that needs to establish a formal agreement or partnership with DHHS DPH WHB.
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DHHS DPH WHB agreement is a document that outlines the agreement between the Department of Health and Human Services (DHHS) and healthcare providers on the reporting of work-related health data.
Healthcare providers are required to file DHHS DPH WHB agreement.
To fill out DHHS DPH WHB agreement, healthcare providers need to provide accurate and complete information about their work-related health data.
The purpose of DHHS DPH WHB agreement is to ensure transparency and accountability in the reporting of work-related health data.
Healthcare providers must report detailed information about work-related health incidents, outcomes, and preventive measures on DHHS DPH WHB agreement.
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