DOH-1013 1991-2025 free printable template
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NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Public Water Supply Protection Flanagan Square, 547 River Street, Room 400 Troy, New York 12180-2216 Report on Test and Maintenance of Backflow Prevention
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How to fill out form doh 1013
How to fill out DOH-1013
01
Obtain the DOH-1013 form from the New York State Department of Health website or from a local health department.
02
Fill in your personal information in the appropriate fields, including your name, address, date of birth, and contact information.
03
Indicate the purpose of the request, specifying the medical records or information you are seeking.
04
Provide details about the healthcare provider or facility that holds your medical records, including their name and address.
05
Sign and date the form to authorize the release of your health information.
06
Submit the completed form to the relevant healthcare provider or agency as instructed.
Who needs DOH-1013?
01
Individuals who require access to their own medical records or health information.
02
Patients who need to authorize the release of their medical information to another provider.
03
Family members or caregivers seeking medical information on behalf of a patient with permission.
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People Also Ask about doh 1013 form pdf
Who pays for backflow prevention device?
A typical backflow prevention device for 'high risk' protection. The property owner is responsible for the costs of installing, maintaining and testing any backflow prevention device.
How do I get backflow certified in Florida?
Becoming a backflow tester in Florida is a relatively straightforward process. You have to get your plumber's license, then pass the backflow tester exam to get your backflow certification. Once you are certified, you must take a recertification course to maintain your license.
How do I get backflow certification in Florida?
Becoming a backflow tester in Florida is a relatively straightforward process. You have to get your plumber's license, then pass the backflow tester exam to get your backflow certification. Once you are certified, you must take a recertification course to maintain your license.
Who can a backflow preventer in Florida?
Florida Statutes require any person installing or repairing a backflow prevention assembly for a customer be a state licensed plumbing contractor. Florida Statutes require any person installing or repairing a backflow prevention assembly on a domestic water system be a state licensed plumbing contractor.
Is a backflow preventer required by code in Florida?
Since 1990, the Florida Building Code has required that residential irrigation systems have a backflow preventer.
Who can test a backflow preventer in Florida?
All backflow prevention assembly(ies) on the Customer's side of the potable water service shall be tested by a Plumbing Contractor who is licensed by the State of Florida.
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What is DOH-1013?
DOH-1013 is a form used for reporting specific health-related data to the Department of Health, typically used by healthcare providers.
Who is required to file DOH-1013?
Healthcare providers and organizations that meet certain criteria established by the Department of Health are required to file DOH-1013.
How to fill out DOH-1013?
To fill out DOH-1013, follow the instructions provided with the form, ensuring all required fields are completed accurately with relevant health data.
What is the purpose of DOH-1013?
The purpose of DOH-1013 is to collect and standardize health data for monitoring public health trends and improving health services.
What information must be reported on DOH-1013?
The information reported on DOH-1013 typically includes patient demographics, service details, diagnosis codes, and treatment outcomes.
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