Forms

Birth Certificates

You can either fill out generate a printable form automatically or print out a PDF version. The form must be printed, signed and mailed to the Vital Records Office. Note: this form is for mail in requests only.

Death Certificates Form

You can either fill out generate a printable form automatically or print out a PDF version. The form must be printed, signed and mailed to the Vital Records Office.

Foodborne Outbreak Investigation Form PDF

This form is used by the State Health Department to report foodborne outbreak investigations to the CDC. Preliminary information is requested within 2 weeks of the first date of illness to identify the outbreak. Completed forms should be returned within 2 months. Please return both forms to the Notifiable Disease Unit at the Georgia Department of Public Health.

Georgia Notifiable Disease Report form

Print out the Notifiable Disease Report form or request copies of the form from gaepinfo@dhr.state.ga.us if you are a health care provider or work for a laboratory and need to report a notifiable disease.

Hearing Screening Annual Report

Form to be completed by the individual directly responsible for the implementation and follow-up of in-school hearing screening program.

Putative Father Form

Add your name to the Putative Father Registry by completing the Putative Father form. By entering your name in the registry, you can be notified about adoption proceedings for any children you have fathered.

Registration Form for the Voice Response System (VRS)

The Voice Resonse system enables enrolled physicians to access newborn screening test results via a touch tone telephone 24 hours a day / 7 days a week.

Surveillance of Hearing Impairment in Infants and Young Children PDF

The Confirmatory Diagnosis Form should be completed for each diagnosed case of hearing loss in children up to age 5 and mailed (in an envelope marked confidential) or faxed (with a cover sheet marked confidential) directly to the district Children 1st Coordinator within 7 days of confirmatory diagnosis, or, if the county of residence of the child is unknown, the form should be mailed or faxed to the state Universal Newborn Hearing Screening and Intervention (UNHSI) program.

Vision Screening Annual Report

Form to be completed by the individual directly responsible for the implementation and follow-up of in-school vision screening program.