Main Content
Article
Forms
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- Communicable Disease
- Immunization
- Laboratories
- Medical Radiology
- School Screening
- Vital Records/Birth/Death Certificates
Communicable Disease
- Adult HIV/AIDS Confidential Case Report
- Animal Bites Report - State Form 14702
- Babesiosis Case Investigation - State Form 52135
- Blood or Body Fluid Exposure, Notification of - State Form 51467
- Confidential Report of Communicable Diseases - State Form 43823
- Hepatitis B and Delta Hepatitis Case Investigation - State Form 52587
- Hepatitis C Case Investigation - State Form 52588
- Histoplasmosis Case Investigation - State Form 52253
- Online Indiana Confidential Sexually Transmitted Disease Report - State Form 56459
- Indiana Confidential Sexually Transmitted Disease Report - State Form 56459
- Influenza-Associated Deaths Case Investigation - State Form 52576
- Influenza Lab Submission - State Form 35212
- Leptospirosis Case Investigation - State Form 52346
- Mosquitoborne Encephalitis Case Investigation - State Form 51382
- Perinatal Hepatitis B Case Investigation - State Form 52589
- Pregnant Women HIV Test History and Assessment - State Form 52048
- Refugee Health Assessment Form - State Form 53700
- Severe Staphylococcus Aureus Infection in a Previously Healthy Person Case Investigation - State Form 53653
- TB - Contact Investigation Report - State Form 50007
- TB - Hospital Reimbursement Claim - State Form 46596
- TB - Monthly TB Follow Up Report - State Form 48092
- TB - Report of Latent Tuberculosis Infection - State Form 49894
- TB - Report of Tuberculosis - State Form 14058
- TB - Request for TB Drugs - State Form 48085
- TB - Tuberculosis Waiver Request - State Form 46595
- Vaccine Administration Record, State Form 54642 (05-06)
- Varicella (Chickenpox) Case Investigation - State Form 5380
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Immunization
- Temperature Log for Vaccines (Celsius)
- Temperature Log for Vaccines (Fahrenheit)
- Refusal To Vaccinate
- Screening Questionnaire for Adult Immunization
- Screening Questionnaire for Child and Teen Immunization
- Vaccine Administration Record for Adults
- Vaccine Administration Record for Children and Teens
- Vaccine Adverse Event Reporting System
- Vaccine Information Statements Q and A
Laboratories
Review all the Clinical and Environmental
Medical Radiology
- Application for Radiology License (Not License Renewal)
- Application for Approval of Radiology Program
- Application for Proficiency Certification for Limited Radiographer
- Board Form X
- Radioactive Materials Registration Application
- Radiation Machine Registration Application
- Renew or Verify a License or Registration
- All licensed individuals (Nuclear Medicine, Radiation Therapy and Radiologic Technologists) may renew their licenses online through the License Express online licensing system
- Online renewal is now available for individuals that hold licenses in multiple categories (e.g. Nuclear Medicine and Radiologic Technology). Please pay for each separately. Notify our office at MedicalRadiology@isdh.IN.gov that you have renewed more than one license. We will initiate the process for refunding the appropriate fees.
School Screening
Vital Records/Birth/Death Certificates
Adoption
- Record of Adoption (State Form 05438)
- Adoption Matching Program: Birth Parent Contact Preference Form - State Form 56535
- Application for Search of Medical History Information for Adoptee - State Form 47261
- Identifying Information Indiana Adoption History Registration - State Form 47896
- Non-Identifying Information Indiana Adoption History Registration - State Form 47897
- Indiana Adoption Medical History Report - State Form 9966
- Indiana Adoption Medical History Registry - State Form 13342
- Indiana Putative Father Registration (State Form 46750) Instructions
- Request for Putative Father Search and Affidavit of Search Results (State Form 54808)
Birth
- Application for Search and Certified Copy of Birth Record - State Form 49607 (R10 / 9-18) Word | PDF
- July 1, 2010 and after - Hospital Paternity Affidavit Form - to be completed by the Hospitals/Birthing Centers only
- July 1, 2010 and after - Local Health Department Paternity Affidavit Form - to be completed by the Local Health Department only
- Establishing Paternity
- Establishing Paternity Brochure
- Application for Search of Paternity Affidavit - State Form 54763
- Paternity Affidavit Upon Marriage - State Form 48468
- Accredited Labs for Paternity Genetic Testing
- Estableciendo Paternidad
- Estableciendo Paternidad Folleto
Death
- Application for Search and Certified Copy of Death Record - State Form 49606 (R8 / 9-18) Word | PDF
- Application for Permit to Disinter, Remove, and Reinter Human Remains - State Form 38697
Indiana Clerk of Courts Documents
Marriage
Terminations
Confidential User Agreements