Forms

Because of the new Adobe forms technology, it is highly recommended that Internet Explorer 11 or later is used for accessing PDF forms whenever possible. 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 in order 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. Microsoft Edge is not recommended or supported. In any case, 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 application
  • 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
193 ANAPHYLAXIS EMERGENCY ACTION PLAN 712 kb 11/22/2016 Y
716 CSHS AUTHORIZATION TO DISCLOSE INFORMATION 544 kb 06/03/2013 Y
757 FINANCIAL DATA FORM 425 kb 08/04/2017 Y
758 FACE AND STATUS SHEET 486 kb 04/05/2011 Y
760 TERMINATION OF CHILDREN'S SPECIAL HEALTH SERVICES 464 kb 08/26/2014 Y
762 ORTHODONISTS REPORT 297 kb 09/23/2009 Y
778 TRANSFER OF CHILDREN'S SPECIAL HEALTH SERVICES 400 kb 09/15/2009 Y
835 CARE COORDINATION PLAN 1004 kb 09/05/2014 Y
1103 REQUEST FOR SERVICES 329 kb 04/05/2011 Y
1724 SERVICE PLAN 365 kb 06/23/2009 Y
1726 HEALTH CARE & FAMILY FUNCTION TIER ASSESSMENT SUMMARY SHEET 279 kb 06/08/2009 Y
1727 HEALTH AND SPECIALITY PROVIDER 258 kb 06/23/2009 Y
3473 APPLICATION OPEN BURNING VARIANCE OF CLEAN WOOD AT LANDFILLS 496 kb 12/18/2014 Y
7054 AUTHORIZATION FOR REGISTRATION OF ANTIFREEZE 335 kb 09/06/2012 Y
8387 REQUEST FOR REIMBURSEMENT-ABANDONED MOTOR VEHICLE PROGRAM 251 kb 06/19/2012 Y
8391 PERMIT APPLICATION FOR TRANSPORTING SOLID WASTE 413 kb 03/05/2013 Y
8399 RELEASE OF ABANDONED MOTOR VEHICLE/SCRAP METAL-ABAND AUTO 323 kb 06/19/2012 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
16932 UNDERGROUND STORAGE TANK CLSOURE 386 kb 06/19/2012 Y
19269 APPLICATION FOR SOLID WASTE MANAGEMENT FACILITY PERMIT 974 kb 06/19/2012 Y
19534 PERMIT BY RULE NOTIFICATION 519 kb 06/19/2012 Y
50278 INERT WASTE DISPOSAL VARIANCE APPLICATION 338 kb 06/19/2012 Y
50336 SOIL MONITORING RESULTS FOR LAND-TREATED PETROLEUM CONTAMINA 215 kb 06/19/2012 Y
50912 CHILD SAFETY SEAT CHECKUP 1334 kb 12/13/2016 Y
51061 FEMALE TARGET AND INITIAL HISTORY 1162 kb 11/29/2011 Y
51098 WASTE DISPOSAL VARIANCE APPLICATION 349 kb 06/19/2012 Y
51450 EMERGENCY WASTE DISPOSAL VARIANCE NOTIFICATION 246 kb 06/19/2012 Y
51601 LAND TREATMENT VARIANCE APPLICATION 631 kb 06/19/2012 Y
51746 REQUEST FOR AUTHORIZATION TO SELL BULK ANTIFREEZE 234 kb 06/19/2012 Y
53326 INERT WASTE LANDFILL ANNUAL REPORT 1409 kb 07/18/2017 Y
54097 NOTIFICATION FOR CONCRETE/ASPHALT RECYCLING FACILITIES 392 kb 09/03/2013 Y
54344 ND DOT PROJECTS-INERT WASTE DISPOSAL VARIANCE APPLICATION 557 kb 06/19/2012 Y
58493 PAP SMEAR FLOW SHEET 225 kb 04/16/2007 Y
58750 LAND TREATMENT ANNUAL REPORT 324 kb 06/19/2012 Y
58980 INERT WASTE BENEFICIAL USE APPLICAION 480 kb 06/19/2012 Y
58981 NDDOT PROJECTS-INERT WASTE BENEFICIAL USE APPLICATION 501 kb 06/19/2012 Y
59155 INITIAL HISTORY - FEMALE 1280 kb 11/29/2011 Y
59187 ASTHMA ACTION PLAN 385 kb 10/09/2017 Y
59226 REQUEST FOR RESPONSIBILITY EXEMPTION/REGULATORY ASSURANCE 452 kb 06/19/2012 Y
59499 NDQUITS REFERRAL 465 kb 04/11/2016 Y
59615 APPLICATION FOR DESIGNATION OF PRIMARY STROKE CENTER 308 kb 06/04/2012 Y
60120 WASTE REJECTION REPORT 469 kb 02/19/2015 Y
60237 ENVIRONMENTAL RECORDS REQUEST 336 kb 10/16/2012 Y
60804 AUTISM SPECTRUM DISORDER REPORT 1772 kb 09/17/2015 Y