This page contains Department of Health (DOH) program-specific forms, reports, and information related to the Consolidated Contract for use by Local Health Jurisdictions.
If you have questions about these materials and/or any programs not listed here, contact designated DOH program staff [see Contact List (Word)].
Documents posted in PDF will be made available in an alternative format upon request for users who are unable to download or view PDF files on the Web. To request an alternative format, contact the specifc program [see Contact List (Word)].
Children with Special Health Care Needs (CSHCN)
- Children with Special Health Care Needs (CSHCN) Manual (PDF) Dec 2017 (available online only)
- CSHCN Health Services Authorization (Word) Sept 2014
HIV Prevention
The two Client Satisfaction Survey forms are to be used by HIV Counseling and Testing programs to conduct a client satisfaction survey at least one time during the year. There are two different surveys: one for standard testing and one for rapid testing. The length of time this survey is conducted and number of clients surveyed is up to the funded agency. A summary report of the aggregate data from these surveys is due 30 days from survey completion and no later than December 31.
The Observation Report form is the reporting form agencies should use to report on the observations they do of HIV Testing Counselors. The report is due 30 days from observation and no later than December 31.
- HIV Test Counseling Client Satisfaction Survey (Word)also in Spanish (Word)
- HIV Counseling, Testing and Referral - Staff Observation Report (Word)