- Washoe County Health District
- Clinic and Office Locations
- Forms - Applications
- News Center
- Programs and Services
- Air Quality
- Environmental Health
- Birth and Death Records
- Community and Clinical Health Services
- Chronic Disease Prevention Program
- 5210 Healthy Washoe
- Active Living
- Be Tobacco Free
- Baby & Me Tobacco Free
- Extra Mile Award / Hospitality Hero Award
- Get Help Quitting
- Importance of Being Tobacco-Free
- LGBTQ Populations
- Nevada Clean Indoor Air Act
- Other Tobacco Products
- Secondhand Smoke
- Smoke-Free Housing
- Smoke Free & Vape Free Outdoor Events
- E-Cigarettes
- Smoke-Free Environments (Lodging/Bars)
- Chronic Diseases
- For Businesses
- For Health Care Professionals
- Healthy Living Forums
- Healthy Eating
- Marijuana
- Media and Reports
- We Order Well - W.O.W!
- Wolf Pack Coaches Challenge
- Immunization Program
- How to Access Immunization Records
- Influenza ("Flu") Season Information
- Información Importante Sobre Vacunas
- Pertussis Information
- Childcare, School, and College Immunization Requirements
- Additional Immunization Clinics and Information
- Information for Childcare Providers
- Immunization and Vaccine Links
- Maternal Child Health Program
- Sexual Health Program
- Tuberculosis Prevention and Control Program
- WIC
- Regulations Governing Community and Clinical Health Services
- HIPAA and Necessary Clinic Documents
- Chronic Disease Prevention Program
- Communicable Diseases and Epidemiology
- Emergency Medical Services Oversight Program
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- REGULATIONS - Washoe County Health District
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- Illness, Injury, and Safety Information
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- Submit a Complaint
- Social Media
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- About Us
- Contact Us
HIPAA and Necessary Clinic Documents
HIPAA & Privacy
- Notice of Health Information Practices for the Washoe County Health District
- Aviso de las Prácticas de Información de su Salud Distrito de Salud del Condado de Washoe
- Notice of Health Information Practices Acknowledgement (Aviso de las Prácticas e Información de Salud Reconocimiento)
Client Information Sheet
The Client Information Sheet is a necessary form for the clinic and is in both English and Spanish. Filling out this form, printing it, then giving the finished form to a clerk will help speed-up check-in at the clinic.
Client Information Sheet - English
Client Information Sheet - Spanish
Last modified on 02/15/2018