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Page 1 of 2BRANCH HILLSDALE ST. JOSEPH COMMUNITY HEALTH AGENCY COVID-19 VACCINATION FORM Last Name:First Name:Middle:Gender:DOB:Age:Street Address: City:Phone: State:Zip Code:Screening Checklist for
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The Branch-Hillsdale-St.Joseph Community Health Agency is a public health organization serving the residents of Branch, Hillsdale, and St. Joseph counties in Michigan.
Healthcare facilities and providers in the Branch, Hillsdale, and St. Joseph counties are required to file with the Community Health Agency.
To fill out the form, healthcare facilities and providers must provide information on their services, patients served, and any public health initiatives.
The purpose of the agency is to promote and protect the health of residents in the three counties through various public health programs and services.
Information such as patient demographics, services provided, public health initiatives, and outcomes must be reported on the form.
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