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Please email a PDF copy of the entire application package to: dph.hic@ct.govAPPLICATION CHECKLIST. The completed application submitted to the HIC must include the following: ? This form filled out
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What is CT Department of Public Health (CT DPH) s & Checklists Form?

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The CT Department of Public refers to the Connecticut Department of Public Health, which oversees public health initiatives, disease control, health education, and the welfare of residents in Connecticut.
Individuals or organizations that have specific public health reporting requirements, such as healthcare providers, facilities, or researchers collecting health data, are required to file with the CT Department of Public Health.
To fill out forms for the CT Department of Public Health, carefully follow the instructions provided with the specific form, ensure that all required information is accurately completed, and submit the form through the designated method (online, by mail, etc.).
The purpose of the CT Department of Public Health is to protect and improve the health of the population through disease prevention, health promotion, and ensuring access to healthcare services.
Information that must be reported includes patient health data, communicable disease information, outbreak reports, environmental health issues, and compliance with health regulations.
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