DCHD Forms

General Forms

DCHD Job Application Douglas County Medical Reserve Corps Application

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HIPAA Forms

Authorization for Release of Medical Information

 

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Nursing Forms

Children’s Flu Vaccination Consent Form – English Adult Flu Vaccination Consent Form – English Children’s Flu Vaccination Consent Form – Spanish Adult Flu Vaccination Consent Form – Spanish Influenza Vaccine VIS

 

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Dental Forms

Dental Registration Form

 

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Environmental Forms

Septic Form Plan Review Application Temporary Food Permit Cottage Food Registration Form (PDF) Food Safety Plan (PDF) Cottage Food Self-Checklist (PDF)

 

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COVID-19 Vaccine Forms

Johnson & Johnson Consent Form Johnson & Johnson EUA

 

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Moderna Consent Form – English Moderna EUA – English Moderna Consent Form – Spanish Moderna EUA – Spanish

 

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Pfizer Consent Form – English Pfizer Fact Sheet – English Pfizer Consent Form – Spanish Pfizer Fact Sheet – Spanish

 

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