Main Content
Article
Providers
Communicable Disease
- Adult HIV/AIDS Confidential Case Report
- Animal Bites Report - State Form 14702 (R3/4-04)
- Babesiosis Case Investigation - State Form 52135 (5-05)
- Blood or Body Fluid Exposure, Notification of - State Form 51467 (11-11)
- Confidential Report of Communicable Diseases - State Form 43823 (R2/11-96)
- Hepatitis B and Delta Hepatitis Case Investigation - State Form 52587 (R/11-09)
- Hepatitis C Case Investigation - State Form 52588 (R/11-09)
- Histoplasmosis Case Investigation - State Form 52253 (7-05)
- 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 (2-06)
- Influenza Lab Submission - State Form 35212
- Legionellosis Case Investigation - State Form 49817 (R2/5-05)
- Leptospirosis Case Investigation - State Form 52346 (8-05)
- Mosquitoborne Encephalitis Case Investigation - State Form 51382 (R/4-04)
- Perinatal Hepatitis B Case Investigation - State Form 52589 (2-06)
- Pregnant Women HIV Test History and Assessment - State Form 52048 (R/3-11)
- 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 TB 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 53800
HIPAA
- 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
Review all the Clinical and Environmental
- 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.
Vital Records
Birth
- Adoption Matching Program: Birth Parent Contact Preference (State Form 56535)
- Record of Adoption State Form 5438
- 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
- Application for Search and Certified Copy of Birth Record - State Form 49607 (R10 / 9-18) Word | PDF
Death
- Application for Search and Certified Copy of Death Record - State Form 49606 (R8 / 9-18) Word | PDF
- Indiana Death Registration System (IDRS)
Indiana Clerk of Courts Documents
- Adoption History Fee Transmittal-SF27337
- Certified Court Order to Change Birth Record to Establish Paternity or Other Changes to Birth Record - State Form 47970 (R6/7-12)
- Putative Father Registry Fee Transmittal-SF46784
Marriage
Terminations
Confidential User Agreements