Document Repository

WIC Forms & Resources

Forms – Online Submission

• WIC Consent with SWDH Programs
• WIC Consent with SWDH Programs – Spanish
• WIC Proof of Lawful Presence Attestation Form
• WIC Proof of Lawful Presence Attestation Form – Spanish

Resources

• WIC Participant Rights, Responsibilities and Consent – EN and SP

Behavioral Health Forms

• Telehealth Informed Consent [PDF]
• Telehealth Informed Consent [Online Submission]
• Magellan Bill of Rights [PDF]
• Magellan Bill of Rights  [Online Submission]
• Release of Information [PDF]
• Release of Information [Online Submission]
• BH Informed Consent and Service Agreement [PDF]
• BH Informed Consent and Service Agreement [Online Submission]
• Minors Authorization Blanket Consent [PDF]

 Formularios-Espanol

• Consentimiento Informado para Telemedicina
• Carta de Derechos de Magellan
• Consentimiento Informado y Acuerdo de Servicios
• Autorización para Divulgación de Información

Informational Documents

• Notice of Privacy Practices
• Patient Rights and Responsibilities
• Mental Health Fee Schedule

Informativos-Espanol

• Aviso de Prácticas de Privacidad
• Derechos y Responsabilidades del Paciente

Food

• Food Establishment License Application
• Food Establishment Plan Review Application

Water

• Private Well Owner Drinking Water Analysis Test Request Form

Land Development

• Subdivision Application
• Subdivision Engineering Report (SER)
• SER Sanitary Restriction Language

Septic Installers

• Subsurface Sewage Disposal System Installer Permit Application

Septic Systems

• Subsurface Sewage Disposal Application
• Accessory Use Approval Application and Plot Plan

Resources

• Disinfecting Your Well
• Hydrogen Sulfide in Drinking Water
• Harmful Algal Blooms Info
• 2025 Current Gravel List
• Proper Sewage Clean Up Procedures

Fillable Forms

Lawful Presence

• EH Proof of Lawful Presence

Food

• Temporary Food Establishment License Application & Lawful Presence
• Event Coordinator Application
• Cottage Food & Low Risk Food Operation Application
• Food Establishment License Application & Lawful Presence

Pumper Trucks

• Pumper Truck Application & Lawful Presence

Record Requests

• Septic Record Request

C. Difficle

Enhanced Barrier Precautions

LTCF Flu Outbreak Tool Kit

• Algorithms for Prevention and Management of Clostridium Difficile
• Hand Hygiene Assessment
• Environmental Cleaning Assessment
• Early Identification and Containment of CDIContact Precautions Signage
• Clostridiun Difficle Guidelines
• Antibiotic Stewardship Assessment

• Enhanced Barrier Precautions (EBP)
• Enhanced Barrier Precautions (EBP) Presentation

• CDC Contamination Cleaning
• Tool Kit Intro
• PCP Letter Template
• Influenza Surveillance Update
• Influenza outbreak Toolkit
• Help Protect Our Residents
• Flu Specimen Collection Poster
• Flu Outbreak Signage
• Flu Line List Template

Norovirus

Misc

• Line List Template
• Norovirus Outbreak Toolkit

• Candida Auris Outbreak Toolkit
• Prevention And Control of Respiratory Illness in LTCFs
• NACCHO LHD Infection Prevention Control Toolkit
• COVID-19 Guidance ALF and ICF
• COVID 19 Guidance SNF

Daycare- ARI

Hand Foot and Mouth

School- Acute GI Toolkit

School- ARI

School- Chicken Pox

School- Impentigo

School- Head Lice

School- Measles

School- Ringworm

School- Pertussis