Allen County Public Health
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CMH Forms and Brochures

  • Home
  • Nursing
  • Children with Special Needs (CMH Program)
  • CMH Forms and Brochures

Brochures

General CMH Information Brochure
Public Health Nurse Services brochure
Preparing Makes Sense for People with Disabilities
Family Handbook for Children with Special Needs

 

Forms

Financial Application to apply for Ohio Children With Medical Handicaps (CMH)
Release of Information and Consent- for 18 yrs. and older
Permission to discuss with another adult
Request to Change Managing Physicians
Medical Application Form (MAF)

 Informational Sheets

HIPPA-notice of privacy practices
Medicaid Guidelines
Steps to Meet Your Cost Share

 

Allen County Public Health is an equal opportunity employer and provider of services. Copyright © 2023. All Rights Reserved.
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Allen County Public Health
219 E. Market St.
Lima, OH 45801
419-228-4457