Forms

Because of the Adobe forms technology, it is highly recommended that Internet Explorer 11 or later is used for accessing PDF forms whenever possible. Microsoft Edge is not recommended or supported. If you must use Chrome or Firefox, please follow the instructions listed below.

Adobe PDF Viewer

PDF forms require an Adobe PDF Viewer browser plug-in. The latest versions of Chrome and Firefox do not support this technology by default. Some additional configurations need to be made to these browsers for them to work properly. Depending on your version of Chrome or Firefox, the instructions may vary slightly. When possible, use Internet Explorer 11 or higher. Adobe Reader needs to be installed on your machine. After Adobe Reader is installed, proceed with the instructions below for your specific browser.

Chrome

Replace the Chrome built in PDF viewer so that you can open, view, and save PDF's without issues.

  • Type into the address window of Chrome browser: chrome://settings/content
  • Scroll down and click on PDF documents
  • Slide the slider to the right next to Open PDFs using a different
  • Click on a form number hyperlink
  • Click on the up arrow on the pdf download box in lower left corner of screen
  • Choose Always open in Adobe Reader

Firefox

Trying to open PDFs in Firefox could result in an error message that states "This PDF document contains forms. The filling of form fields is not supported."

To get the form to open in Adobe, you need to do the following:

  • Open Firefox
  • Click the Tools menu button
  • Click Options and select Applications
  • Find Portable Document Format (PDF) in the Content Type column
  • In the Action column, change it to Use Adobe Acrobat

Department of Health - Public Form(s)

SFNTitleSizeDateFillable
716 SHS AUTHORIZATION TO DISCLOSE INFORMATION 1476 kb 03/26/2019 Y
757 FINANCIAL DATA DOCUMENT 916 kb 04/21/2020 Y
758 FACE AND STATUS SHEET 591 kb 12/17/2018 Y
760 TERMINATION OF SPECIAL HEALTH SERVICES 453 kb 12/17/2018 Y
762 ORTHODONISTS REPORT 913 kb 06/14/2019 Y
835 CARE COORDINATION PLAN 1082 kb 06/04/2019 Y
1103 REQUEST FOR SERVICES 449 kb 12/17/2018 Y
5531 REQUEST FOR COPY OF DEATH CERTIFICATE 1563 kb 12/23/2019 Y
8140 REQUEST FOR COPY OF BIRTH CERTIFICATE 1559 kb 12/19/2019 Y
8618 CLIENT FLOW SHEET 191 kb 04/16/2007 Y
8620 EXAM 992 kb 12/23/2011 Y
8625 INCOME WORKSHEET 433 kb 11/29/2011 Y
8627 MEDICATION PROFILE 150 kb 04/16/2007 Y
8633 MALE VISIT 921 kb 11/29/2011 Y
51061 FEMALE TARGET AND INITIAL HISTORY 1162 kb 11/29/2011 Y
58493 PAP SMEAR FLOW SHEET 225 kb 04/16/2007 Y
58698 AUTHORIZATION TO RECEIVE A CERTIFIED COPY 945 kb 12/23/2019 Y
59155 INITIAL HISTORY - FEMALE 1280 kb 11/29/2011 Y
59499 NDQUITS REFERRAL 447 kb 11/21/2019 Y
60804 AUTISM SPECTRUM DISORDER REPORT 1083 kb 04/24/2019 Y
61643 REQUEST FOR CERTIFIED COPY OF A FETAL DEATH RECORD 1624 kb 01/02/2020 Y
61645 REQUEST FOR CERTIFIED COPY OF AN ACKNOWLEDGMENT OF PATERNITY 1573 kb 12/23/2019 Y
61754 PARENT CONSENT FOR PUBLIC HEALTH HYGIENCE SERVICES 952 kb 01/14/2020 Y