DOH-352 2012 free printable template
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YOU MUST COMPLETE THIS SECTION IN ITS ENTIRETY FOR THIS APPLICATION TO BE PROCESSED Course Subject DOH-352 11/12 Page 1 of 2 Dates Contact Hours Location Sponsor Signature. NEW YORK STATE DEPARTMENT OF HEALTH Center for Environmental Health Bureau of Water Supply Protection Empire State Plaza Corning Tower Room 1110 Albany New York 12237 Application for Renewal of Certification Water Treatment Plant or Distribution System Operator Instructions To avoid your application being rejected please...
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How to fill out DOH-352
How to fill out DOH-352
01
Obtain the DOH-352 form from the New York State Department of Health website or through your local health department.
02
Fill out the 'Applicant Information' section, providing your name, address, and contact information.
03
In the 'Details of the Request' section, specify the reason for the request and any relevant details that pertain to your submission.
04
If applicable, complete the 'Provider Information' section by entering the name and contact information of the healthcare provider associated with the request.
05
Review the form for accuracy, ensuring all fields are filled out correctly and completely.
06
Sign and date the form to validate your request.
07
Submit the completed form through the specified method (online submission, mail, or fax).
Who needs DOH-352?
01
Individuals who are requesting access to their health records or information for personal, legal, or medical purposes.
02
Healthcare providers who require the form to facilitate the transfer of patient information.
03
Public health organizations and agencies that need to obtain health data for analysis or reporting.
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What is DOH-352?
DOH-352 is a form used by the New York State Department of Health to report specific public health information.
Who is required to file DOH-352?
Health care providers, including hospitals and certain outpatient facilities, are required to file DOH-352.
How to fill out DOH-352?
DOH-352 must be filled out by providing accurate patient information, including demographics, diagnosis, and treatment details, as outlined in the form instructions.
What is the purpose of DOH-352?
The purpose of DOH-352 is to collect health data that is essential for monitoring public health trends and outbreaks.
What information must be reported on DOH-352?
The DOH-352 form must report patient identifiers, clinical information, treatment procedures, and any relevant health conditions related to public health surveillance.
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