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DHMH 4492.) DEMOGRAPHIC DATA PATIENT INFORMATION SEND TO YOUR LOCAL HEALTH DEPARTMENT Patient s Name (Last) (First) Patient s Address City Home Telephone County of Residence Ethnicity: Hispanic or Latino Daycare Date of Birth State Cellphone Not Hispanic or Latino Age Zip MORBIDITY DATA Male Female Current Gender Male Female M to F Transgender F to M Transgender Other Race: American Indian or Alaskan Native Asian Black or African American Hawaiian or Pacific Islander Whi.

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​​Health care providers in Maryland are required to report the following STIs to the local health department of the jurisdiction where the patient resides: chancroid, chlamydia, gonorrhea, hepatitis, HIV and syphilis.

​​​​​​​Confidential Morbidity Report (CMR) forms for reporting communicable diseases, tuberculosis, loss of consciousness or control, and animal patients are provided below. CMR - COVID-19. CMR - Communicable Diseases​​

How to File a Complaint​ Department of Health's Office of Health Care Quality, contact their office at (410) 402-8015 or visit their web site at health.maryland.gov/ohcq/Pages/home.aspx. Department of Human Services, contact their office at 1-800-332-6347 or visit their web site at .dhr.state.md.us/ssa/license.htm.

The Maryland Department of Health is the part of the state government that oversees public health. Medicaid is part of the Maryland Department of Health.

United States Secretary of Health and Human Services Flag of the secretary Incumbent Xavier Becerra since March 19, 2021 United States Department of Health and Human Services Style Mr. Secretary (informal) The Honorable (formal)13 more rows

Maryland Department of Health Secretary Laura Herrera Scott explains how you can make a difference by carrying naloxone, an opioid overdose reversal medication available all over Maryland: StopOverdose.maryland.gov #RecoveryMonth.

Rafael J. Lopez, Maryland Secretary of Human Services.

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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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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