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Departmental Forms

Departmental Forms

Reporting & Provider Departmental Forms & Information

A library of Michigan Department of Community Health forms used by health care providers.

Affidavit of Parentage

Download Affidavit of Parentage form.

Affidavit of Parentage

Birth Defects Reporting Forms

Download the birth defects reporting form, birth defects reporting handbook, the cytogenetics reporting form and the cytogenetics reporting manual.

Birth Defects Reporting Forms

Communicable Disease Case Definitions and Case History Forms

Information on case definitions and case history forms for reportable diseases and conditions.

Communicable Disease Case Definitions and Case History Forms

Death Certificate (Revised)

Instructions for completing the revised death certificate (1/2004). Includes the latest Michigan Place Name List and a sample death certificate.

Death Certificate (Revised)

Divorce and Annulment

Download a form to be used to record and report a divorce or annulment.

Divorce and Annulment

Fetal Death Reporting Forms

Download the fetal death reporting forms and instructions.
Fetal Death Reporting Forms

Michigan Cancer Surveillance Program

Download the current Michigan Cancer Surveillance Program Cancer Report Form, Cancer Program Manual, and other MCSP-related documents.

Michigan Cancer Surveillance Program

Michigan's Dignified Death Act

Information about your right to make choices about your medical treatments. This includes the right to accept or refuse any treatment that is offered to you. It also covers your right to have someone else make choices for you if you can no longer choose for yourself.
Michigan's Dignified Death Act

Verification of Pregnancy & Gestational Age

For local health department use only. Completion is required if the patient requests a pregnancy verification and determination of gestational age in order to fulfill the requirements of the Informed Consent for Abortion Law, PA 345 of 2000.
Pregnancy & Gestational Age Verification Form