Clinic

• Things to bring to your screening
• Authorization to Disclose DH3203
• Client Eligibility Registration Form
• Consent To Fax DH2116
• Health History (Only for annual or method start)
• Household Data Sheet DH3058
• Initiation of Services DH3204   (Instructions)
• Notice of Privacy Practices DH150741
• Health Insurance Application for Pregnant Woman
• Health Insurance Application for Extended Family Planning Benefits

Spanish

• Autorización para Divulgar Información Confidencial DH3203S
• Consentimiento del Client para Enviar Información Confidencial por Fax DH2116S
• Comienzo de Servicios DH3204S
• Aviso sobre Normas de Privacidad DH150742
• Historia Médica de la paciente
• Forma Para Registracion de Eligibilidad
• Solicitud de Seguro de Salud para Mujer Embarazada
• Solicitud para Seguro de Salud Para Beneficios Extendidos de Planificación Familiar

Creole

• Otorizasyon pou Bay Enfòmasyon Medikal Mwen Ki Sekrè DH3203H
• Konsantman Klyan-An Pou Yo Voye Pa Faks Enfòmasyon Konfidansyèl-Yo DH2116H
• Avi Sou Practik Konsènan Lavi Prive DH150743
• Aplikasyon Asirans Pou Fanm Ansent
• Aplikasyon asirans medikal pou ekstansyon benefis plannin familyal

Environmental Health

• Credit Card Authorization Form

Septic System Forms

• Application for Abandonment Permit
• Application for Construction Permit
• Business Survey
• Deed Notice for PBTS systems
• Existing System and System Repair Evaluation
• Initial Inspection Request Form
• Letter of Authorization for new/repair system applications
• Operating Permit Application
• Utility Easement Agreement for Duplexes
• Variance Application

Biomedical Waste Forms

• Biomedical Waste Monthly Log

• Biomedical Waste Generator Permit Application
• Body Piercing Salon Application

Food Establishment Forms

• Food Service Permit Application (DOH)
• Food Service Plan Review Application (LeeCHD)
• Food Service Plan Review Guide (LCHD)

Migrant Labor Housing Forms

• Migrant Labor Housing Application

Mobile Home / RV Park Forms

• Mobile Home/Recreational Vehicle Park Permit Application
• Recreational Vehicle Park Site Schedule

Public Swimming Pool Forms

• Monthly Swimming Pool Report (DOH)

Tanning Forms

• Tanning License Application Packet

Environmental Engineering

• Application for Chemical Feeder Alteration
• Application for Resurfacing of Commercial Pool/Spa
• Application for Exemption more than 32 Units
• Application for Exemption 32 Units or less