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DHSS Reorganization
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Department of Health
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Public Health
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Public Health Nursing
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Registration Forms
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Registration Forms
Download, print, and fill out the forms that you will need for your appointment.
ALL patients
need to fill out
forms 1, 2, and 3
.
Fill out additional forms as instructed by Public Health Nursing Staff.
Call for an appointment. (
Find a Public Health Center
)
PLEASE DO NOT EMAIL the forms; they contain your Protected Health Information.
Client Registration Form
DHSS Acknowledgement of Privacy Notice (06-5876) 09-03
DHSS Notice of Privacy Practices
Release of Information
Reproductive Health History - Female
Reproductive Health History - Male
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