New York State Department of Health

Forms
New York State Disposal/Destruction Request
Outpatient Data Elements Form
Case Closure Summary Form
Autorización para divulgación de Información sobre salud
New York Monthly Cash Receipts Assessment Report Certification
Environmental Considerations Checklist
New York AEMT Rapid Recertification Application
New York State Donate Life Registry Enrollment Form
New York State Permit to Operate Application
New York Electronic Filing User ID Application
New York HIV Test Offer Form
New York State Tobacco Control Program Invitation for Bid
New York Assisted Living Resident Personal Data Form
Transmittal Form
Request for Verification of Birth
New York Meningococcal Vaccination Response Form
New York Medicaid Health Home Opt-Out Form
NYS WIC Medical Documentation Form
DSS-4449B Facility Admission Form
Statement of Administrator Qualifications - Adult Residential Care Facilities
New York Cardiac Surgery Report Form DOH-2254a
New York Medicaid Application Form