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New Hampshire Confidential STD Reporting Form PATIENT INFORMATION Last Name First Name MI DOB // Address City/State/Zip Employer Home Phone Cell Phone Work Phone Sex Male Race White Ethnicity Pregnant - due date // Female Black Hispanic Asian Pacific Islander Not Pregnant Amer Indian/Alaskan Native Marital Status Non-Hispanic Primary language Single Multiracial Other/Unk Married Divorced Please indicate all Sexually Transmitted Disease testing pe.

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Providers without internet access should ask for alternate arrangements by calling the Medicaid Provider Call Center at (866) 291-1674 or (603) 223-4774.

There are three New Hampshire Medicaid Health Plans to choose from: AmeriHealth Caritas New Hampshire. NH Healthy Families. WellSense Health Plan.

Contact the DHHS Customer Service Center toll-free at 1-844-ASK-DHHS (1-844-275-3447) (TDD Relay Access: 1-800-735-2964), Monday through Friday, 8:00 a.m. to 4:00 p.m. ET. Contact your local District Office.

Infectious disease management essentially consists in identifying the microbial cause(s) of an infection, initiating if necessary antimicrobial therapy against microbes, and controlling host reactions to infection.

NH Healthy Families provides the same benefits as Medicaid, plus more. In this section, you can learn about the health benefits, pharmacy services and value added services NH Healthy Families offers. Need help understanding these benefits and services? Call us at 1-866-769-3085 (TDD/TTY 1-855-742-0123).

Medicaid for Employed Adults with Disabilities (MEAD) is for ages 18 through 64. Medicaid for Employed Older Adults with Disabilities (MOAD) is for age 65 or older. Both MEAD and MOAD provide Medicaid (medical assistance) to adults with disabilities who are working. MEAD and MOAD have higher income and resource limits.

Economic Benefits Since Medicaid Expansion was first implemented in New Hampshire from August 2014 until June 2022, the program has brought nearly $3.23 billion in federal funds to New Hampshire, supporting the health of Granite Staters and the economy.

Diseases reportable to the CDC include: Anthrax. Arboviral diseases (diseases caused by viruses spread by mosquitoes, sandflies, ticks, etc.) such as West Nile virus, eastern and western equine encephalitis.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232