| Applications |
|
|
11/19/2009 |
- |
Parish Utility Letter - This document is part of the application packet for a new
Permit to Operate from the Food and Drug Unit. It should be
included with your plans review questionnaire and
site/facility plans. |
|
|
10/27/2009 |
- |
Bottled Water Importer's Information Packet - A packet of information for manufacturers or distributors
of bottled water in other states or foreign countries
wishing to import product into the state of Louisiana |
|
|
10/27/2009 |
- |
Bottled Water Manufacturer's Information Packet - A packet of information for citizens interested in opening
a new bottled water manufacturing plant in the state of
Louisiana |
|
|
10/27/2009 |
- |
Bottled Water Manufacturer's Information Packet - A packet of information on requirements to open a bottled-
water manufacturing facility in the state of Louisiana |
|
|
10/27/2009 |
- |
Certificate of Free Sale - This certificate stipulates that your firm is permitted in
the state of Louisiana and has products registered with
FDU. Furthermore, it states that your facility is in
compliance with cGMP, as delineated in Part VI of Title 51,
L.A.C.
|
|
|
10/27/2009 |
- |
FD-35(N) Application for a New Out-of-State Soft Drink Registration - application to register flavors of soft drinks manufactured
out-of-state (or bearing out-of-state responsible party
information on the label) with the Food and Drug Unit of
the Office of Public Health of the state of Louisiana |
|
|
10/27/2009 |
- |
FD-37 Export Certificate - This certificate declares that your product is registered
and legal to sell within the state of Louisiana |
|
|
10/27/2009 |
- |
FD-37(A) Notarized Export Certificate - This certificate declares that your product is registered
and legal to sell within the state of Louisiana and is
witnessed by a public notary |
|
|
10/27/2009 |
- |
FD-37(B) Bilingual Export Certificate (Spanish) - This certificate declares that your product is registered
and legal to sell within the state of Louisiana and is
presented in both Spanish and English (note that Spanish is
the only foreign language available at this time) |
|
|
10/27/2009 |
- |
FD-56 Application for Commercial Body Art Operator/Manager Registration - application document for prospective commercial body art
operators (artists) or shop managers |
|
|
10/27/2009 |
- |
FD-9(N) Application for a New Product Registration - application form for registering new food, drug, cosmetic,
or prophylactic products with the Food and Drug Unit of the
Office of Public Health of the state of Louisiana |
|
|
10/26/2009 |
- |
H1N1 1135 Waiver Request Form |
|
|
10/21/2009 |
- |
FD-55 Application for Commercial Body Art Facility Registration |
|
|
10/06/2009 |
- |
Friends and Family Transportation Program - Transportation options available to Louisiana Medicaid
recipients. |
|
|
09/01/2009 |
- |
Application for Children's Special Health Services |
|
|
08/20/2009 |
- |
Nurse Aide Training Packet - revised 8-14-09 - This Nurse Aide Training Packet, revised 8-14-09, includes
information relative to the use of an approved curriculum.
Providers may choose this option if they prefer to use one
of the approved curriculums when applying for approval of
a Nurse Aide Training School/Program, although there is no
mandate to use this option at this time. |
|
|
08/17/2009 |
- |
Home and Community Based Services (HCBS) - Application and rule for providers who desire to apply for
Facility Need Review approval for license to operate a
home and community based service (PCA, SIL, Respite). |
|
|
07/21/2009 |
- |
CLIA Application - CLIA Application to Perform Laboratory Testing |
|
|
07/16/2009 |
- |
MPP Brochure and Application (Vietnamese) |
|
|
07/10/2009 |
- |
EarlySteps Referral Form |
|
|
05/18/2009 |
- |
Permanent Supportive Housing Senior Application - This application is for people over the age of 62 applying
for housing through the PSH program. |
|
|
03/11/2009 |
- |
Orleans Parish Marriage License |
|
|
02/20/2009 |
- |
Plan Review Application |
|
|
02/11/2009 |
- |
Girl's Basketball Registration Form |
|
|
02/10/2009 |
- |
AWOP's Completed Fiscal Year 2008 Optimization Assessment Software (OAS) Spreadsheets - This publication contains the Completed FY08 (Oct. 07 -
Sept. 08) Optimization Assessment Software (OAS)
Spreadsheets for each of Louisiana's 59 Community Surface
Water Treatment Plants (SWTPs). |
|
|
01/12/2009 |
- |
LaMOMS - Español |
|
|
01/09/2009 |
- |
LaCHIP |
|
|
01/09/2009 |
- |
Take Charge Application |
|
|
12/11/2008 |
- |
Nursing Home Application - Use for Initial Licensing, CHOWS, Bed Changes, ect...
** Do not use for renewal of license. Please use the
online license for renewal. |
|
|
12/08/2008 |
- |
Medicaid Application for Long Term Care |
|
|
12/08/2008 |
- |
Medicaid Application for Long Term Care |
|
|
12/01/2008 |
- |
2009 EMT Recertification Application - A 2009 Recertification Application must be used to renew
your state certification. Prior versions of the State
Recertification Applications will be returned unprocessed |
|
|
11/20/2008 |
- |
Louisiana Childhood Lead Poisoning Prevention Program (LACLPPP) Data Request Application |
|
|
11/13/2008 |
- |
Rural Access to Emergency Devices Program Application - This Rural Access to Emergency Devices (Rural AED)
application must be completed by every organization
applying for an Automated External Defibrillator (AED).
You must submit a separate application for each AED
requested. This application must be completed in it's
entirety to be considered for placement of an AED. |
|
|
10/22/2008 |
- |
LaMOMS Application - Medicaid health care coverage application for pregnant
women. |
|
|
09/25/2008 |
- |
Family Opportunity Act Medicaid Application |
|
|
06/06/2008 |
- |
DUPLICATE EMT CARD - The Bureau of EMS requires this form in order to get a
duplicate EMT card. Please complete and send appropriate
fees. |
|
|
06/06/2008 |
- |
EMS Certification Application - You must complete this form in order to practice as an EMT
in the State of Louisiana. |
|
|
06/06/2008 |
- |
Exam Reservation Form 2007 - In order to register for the National Registry exam,
please
complete this form completely. Incomplete forms will be
returned. |
|
|
06/06/2008 |
- |
RECIPROCITY APPLICATION AND INSTRUCTIONS - This application must be completed if EMT training and/or
testing was completed out of the State of Louisiana in
order to transfer certification from the other state. |
|
|
06/02/2008 |
- |
LaMOMS - Vietnamese |
|
|
06/02/2008 |
- |
Medicaid Application (Vietnamese) |
|
|
05/30/2008 |
- |
Take Charge - Vietnamese |
|
|
05/27/2008 |
- |
LaCHIP - Español |
|
|
04/23/2008 |
- |
LaCHIP Application - The application for LaCHIP (the Louisiana Children's
Health
Insurance Program), which provides health coverage at no
cost for uninsured children younger than 19 from working
families. |
|
|
02/19/2008 |
- |
Home and Community Based Service Applicants Required Training - Required training class for home and community based
service intial license applicants effective 2/18/08. |
|
|
01/29/2008 |
- |
2008 EMS Recertification Application - EMT's renewing their state certification must use this
application to renew in 2008. |
|
|
12/17/2007 |
- |
Children's Choice Waiver Application |
|
|
12/05/2007 |
- |
Long Term Care Application for SSI Recipients |
|
|
11/30/2007 |
- |
Medicaid Application - This general application is acceptable for most Medicaid
programs except the Long Term Care Program. |
|
|
11/30/2007 |
- |
Medicare Savings Program Application - Louisiana's health benefits to assist those on Medicare. |
|
|
10/25/2007 |
- |
Family Opportunity Act Medicaid Application |
|
|
10/11/2007 |
- |
LaCHIP Renewal Form (SPANISH) |
|
|
10/10/2007 |
- |
TAKE CHARGE Application |
|
|
09/24/2007 |
- |
Medicaid Application (Spanish) |
|
|
09/07/2007 |
- |
Putative Father Affidavit |
|
|
07/31/2007 |
- |
Medicare Savings Program Application Form (Vietnamese) |
|
|
05/18/2007 |
- |
LaCHIP Application Form (Vietnamese) |
|
|
05/18/2007 |
- |
Medicaid Purchase Plan Application - Louisiana's affordable health benefits program for workers
with disabilities. |
|
|
05/18/2007 |
- |
Medicaid Purchase Plan Application - Louisiana's affordable health benefits for worker's with
disabilities. |
|
|
11/13/2006 |
- |
LaCHIP Renewal of Coverage Form (Vietnamese) |
|
|
05/16/2006 |
- |
Nurse Aide Training Packet - revised 5-8-09 - The Nurse Aide Training Packet currently in use, revised
5-8-09, requires providers to develop their own
curriculum. Providers may continue to use this process,
until further notice, when applying for approval of a
Nurse Aide Training School/Program. |
|
|
03/20/2006 |
- |
Hospital Designation for LAHIDD Data Submittal (To be completed by hospital) |
|
|
03/14/2006 |
- |
Registration of Intermediary Submitting LAHIDD Data on Behalf of Hospitals (To be completed by third-party intermediary) |
|
|
02/17/2006 |
- |
Acknowledgment of Paternity Affidavit Forms |
|
|
02/17/2006 |
- |
Birth/Death Certificate Amendments/Corrections |
|
|
02/17/2006 |
- |
Birth/Death Certificate Ordering Package |
|
|
02/17/2006 |
- |
Orleans Parish Marriage Certificates |
|
|
02/17/2006 |
- |
Putative Father Registry |
|
|
04/01/2005 |
- |
Medicare Savings Program Renewal Form |
|
|
02/27/2004 |
- |
Medicaid - Español |
|
|
02/14/2004 |
- |
2003 Laboratory Submission Form For Arboviral Testing In Humans |
|
Print
Email
