Main Office 419-228-4457 WIC 419-224-8200 contact@allenhealthdept.org
Allen County Public Health
  • Nursing
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    • Children with Special Needs (CMH Program)
      • Learn More about CMH
      • CMH Forms and Brochures
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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

Contact Us

  • 219 E. Market St., Lima, OH 45801
  • Main Office 419-228-4457
  • WIC 419-224-8200
  • 24/7 Emergency 419-227-3535
  • If you are calling after business hours to report a public health emergency or a Class A reportable disease, please contact the Allen County Sheriff's Office using the 24/7 Emergency number.
  • contact@allenhealthdept.org

Quick Links

  • Birth Certificates
  • Food License
  • Mammogram & Pap Test
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