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Forms and Publications

Forms

Vital Records  
Application for Vital Record  
Sworn Statement Application  
Environmental Health  
Temporary Food Permit Application
Community Event Organizer’s Permit Application
Farmers Market Permit Application
Food Facility (Restaurant) Permit Application
Food Facility Check/Construction Application
Water System Permit Application
Recreation Health: Swimming Pools/Spas Annual Operating Permit Application

Plan Check: Swimming Pools/Spas Special Purpose Pools/Others
Sewage Disposal System Permit Application
Sewage Disposal System Policy & Procedure  
Solid Waste Collections Vehicle Permit Application
Registration Form: To Engage in the Business of Tattooing, Body Piercing, or Permanent Cosmetics

Certified Unified Program Agency Form
Communicable Disease Prevention & Control Reporting  
Confidential Morbidity Report (CMR) with Reportable Diseases and Conditions
MMWR – Diagnosis and Management of Foodborne Illnesses
MEDICAL MARIJUANA IDENTIFICATION PROGRAM  
Application/Renewal (DHS 9042)  
Fee Schedule and Information  
Written Documentation of Medical Records (DHS 9044)  
Sexually Transmitted Disease (STD)  
Confidential Morbidity Report (CMR) with Reportable Diseases and Conditions
California Gonorrhea Treatment Guidelines (6/25/03)
California STD Treatment guideline for Adults and Adolescents
Tuberculosis  
Confidential Morbidity Report (CMR) with Reportable Diseases and Conditions
Tuberculosis Discharge Plan (GOTCH Form)
San Benito County Guidelines for TB Control in Skilled Nursing Facilities
West Nile Virus  
WNV Specimen Submittal Form (to Santa Clara Lab)
Immunization Program  
Immunization Clinic Listing
VAERS Form


Publications

  
Childcare Health Linkage Resource Manual  
Emergency Preparedness Brochure
Flu Chemo Chart
Public Health Reporting & Referral Resource (Complete Manual)
     ▪  Section A: Communicable Disease
     ▪  Section B: Immunizations
     ▪  Section C: Environmental/Occupational Applications
         and Reports
     ▪  Section D: Public Insurance Programs and Payment
         Resources
San Benito County Health Status Report 2000
MCAH 5-Year Assessment Report 2005-2009
 

Disclaimer

San Benito County Health & Human Services Agency
Public Health Department
439 Fourth Street
Hollister, CA 95023
(831) 637-5367
Fax: (831) 637-9073

© 2007 San Benito County Health & Human Services Agency Public Health Division, All Rights Reserved