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Attachment 9 Cigarette Restitution Fund Program (CROP), Cancer Prevention, Education, Screening and Treatment Program (CHEST) Financial Eligibility Criteria for Cancer Treatment Services, including
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To fill out the State of Maryland DHMH (Department of Health and Mental Hygiene) form, follow these steps:
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Begin by gathering all the required information and documentation. This may include personal details, medical history, and any supporting documents.
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The State of Maryland DHMH form may be needed by individuals or organizations who have a requirement to provide health and mental hygiene information to the state authorities.
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Specific groups and individuals who might need this form include:
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- Patients seeking medical assistance or treatment from Maryland state-funded clinics or health programs.
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It is important to consult the specific guidelines, instructions, or the purpose of the form to determine who exactly needs to fill out the State of Maryland DHMH form in a given situation.

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The Maryland Department of Health and Mental Hygiene (DHMH) is the state agency responsible for promoting health, providing health services, and protecting public health in Maryland.
Individuals or entities required to file with the Maryland DHMH typically include healthcare providers, facilities, and organizations that operate healthcare services or receive state funding.
Filling out the Maryland DHMH forms generally involves providing specific information about the healthcare services offered, financial data, and compliance with state regulations. Detailed instructions are usually provided on the form itself or the DHMH website.
The purpose of the Maryland DHMH is to ensure public health safety, manage health programs, oversee the health workforce, and respond to public health needs in Maryland.
The information that must be reported can include patient data, financial details, compliance with health regulations, services provided, and demographic information.
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