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Documents sorted by HEADER in Ascending Order within category

Physical Paperwork2 documents

  • School and Sports Physical Paperwork - English
    document Header School and Sports Physical Paperwork - English
  • School and Sports Physical Paperwork - Spanish.pdf
    document Header School and Sports Physical Paperwork - Spanish.pdf

Administration Documents19 documents

  • Authorization to Release Healthcare Information
    document Header Authorization to Release Healthcare Information
    Release of Information (ROI)
  • Freedom of Information Act Request Form.pdf
    document Header Freedom of Information Act Request Form.pdf
  • Job Application.pdf
    document Header Job Application.pdf
  • Notice of Privacy Practices.pdf
    document Header Notice of Privacy Practices.pdf
  • Patient Grievance Form.docx
    document Header Patient Grievance Form.docx
  • WCHD IPLAN 2020 2025 Final
    document Header WCHD IPLAN 2020 2025 Final
    WCHD IPLAN 2020 2025 Final
  • Whiteside County Board of Health Bylaws
    document Header Whiteside County Board of Health Bylaws
  • Whiteside County Community Health Clinic Governing Council Bylaws
    document Header Whiteside County Community Health Clinic Governing Council Bylaws
  • Whiteside County Health Department Annual Report FY22
    document Header Whiteside County Health Department Annual Report FY22

Agendas & Minutes2 documents

  • Board of Health
    document Header Board of Health
  • CHC Governing Council
    document Header CHC Governing Council

Board Calendars8 documents

  • Board of Health Schedule of Meetings 2021
    document Header Board of Health Schedule of Meetings 2021
  • Board of Health Schedule of Meetings 2022
    document Header Board of Health Schedule of Meetings 2022
  • Board of Health Schedule of Meetings 2023
    document Header Board of Health Schedule of Meetings 2023
  • Board of Health Schedule of Meetings 2024.pdf
    document Header Board of Health Schedule of Meetings 2024.pdf
  • Governing Council Schedule of Meetings 2021
    document Header Governing Council Schedule of Meetings 2021
  • Governing Council Schedule of Meetings 2022
    document Header Governing Council Schedule of Meetings 2022
  • Governing Council Schedule of Meetings 2023
    document Header Governing Council Schedule of Meetings 2023
  • Governing Council Schedule of Meetings 2024 (Revised 1.10.2024).pdf
    document Header Governing Council Schedule of Meetings 2024 (Revised 1.10.2024).pdf

Clinic Forms28 documents

Behavioral Health Forms12 documents

  • Adult Symptoms - Self Rating Form
    document Header Adult Symptoms - Self Rating Form
  • Authorization - Former Treatment
    document Header Authorization - Former Treatment
  • Authorization - Pre-Filled
    document Header Authorization - Pre-Filled
  • Authorization to Schools
    document Header Authorization to Schools
  • Child-Adolescent Intake Form (For Parent to Complete)
    document Header Child-Adolescent Intake Form (For Parent to Complete)
  • Informed Consent
    document Header Informed Consent
  • Medical History
    document Header Medical History
  • Notice of Privacy Practices
    document Header Notice of Privacy Practices
  • Patient Health Questionnaire - Adult
    document Header Patient Health Questionnaire - Adult
  • Patient Information
    document Header Patient Information
  • Pediatric Symptom Checklist (For Parent to Complete)
    document Header Pediatric Symptom Checklist (For Parent to Complete)
  • Verification of Income
    document Header Verification of Income

Dental Forms4 documents

  • Dental Medical History
    document Header Dental Medical History
  • Notice of Privacy Practices
    document Header Notice of Privacy Practices
  • Patient Information
    document Header Patient Information
  • PATIENT INTAKE - Verification of Income (1-16-24)
    document Header PATIENT INTAKE - Verification of Income (1-16-24)

Family Planning6 documents

  • Change in Billing
    document Header Change in Billing
  • Family Planning Demographics
    document Header Family Planning Demographics
  • Family Planning Initial Medical History
    document Header Family Planning Initial Medical History
  • Notice of Privacy Practices
    document Header Notice of Privacy Practices
  • Reproductive Life Plan
    document Header Reproductive Life Plan
  • STD Risk Assessment Survey
    document Header STD Risk Assessment Survey

Medical Forms6 documents

  • Medical History Form.pdf
    document Header Medical History Form.pdf
  • Notice of Privacy Practices.pdf
    document Header Notice of Privacy Practices.pdf
  • Patient Health Questionnaire - Adolescent.pdf
    document Header Patient Health Questionnaire - Adolescent.pdf
  • Patient Health Questionnaire - Adult.pdf
    document Header Patient Health Questionnaire - Adult.pdf
  • Patient Information
    document Header Patient Information
  • Verification of Income and Family Size.pdf
    document Header Verification of Income and Family Size.pdf

Fee Schedules2 documents

  • CHC Special Event Fees 2024.pdf
    document Header CHC Special Event Fees 2024.pdf
  • Immunization Fees
    document Header Immunization Fees
    Immunization Costs if Not Covered by Insurance

Job Application1 document

  • Whiteside Application for Employment
    document Header Whiteside Application for Employment

Press Releases19 documents

  • 2022.02.25 WCHD No Appointment Required SHIELD Testing
    document Header 2022.02.25 WCHD No Appointment Required SHIELD Testing
  • 2022.05.23 COVID-19 Automated Case Notification Begins June 1
    document Header 2022.05.23 COVID-19 Automated Case Notification Begins June 1
  • 2022.06.02 First Probable Case of MPV in Illinois
    document Header 2022.06.02 First Probable Case of MPV in Illinois
  • 2022.06.29 WCHD SHIELD Testing Paused
    document Header 2022.06.29 WCHD SHIELD Testing Paused
  • 2022.07.01 WCHD SHIELD Community Testing Reopens July 6th
    document Header 2022.07.01 WCHD SHIELD Community Testing Reopens July 6th
  • 2022.08.03 MPV Vaccine Not Yet Available in Whiteside County
    document Header 2022.08.03 MPV Vaccine Not Yet Available in Whiteside County
  • 2022.08.05 Mosquitoes Test Positive for West Nile Virus Near Sterling IL
    document Header 2022.08.05 Mosquitoes Test Positive for West Nile Virus Near Sterling IL
  • 2022.08.09 First Case of MPV in Winnebago County
    document Header 2022.08.09 First Case of MPV in Winnebago County
  • 2022.08.25 First MPV Case in Dekalb County
    document Header 2022.08.25 First MPV Case in Dekalb County
  • 2022.09.01 Bivalent COVID-19 Updated Booster Approved
    document Header 2022.09.01 Bivalent COVID-19 Updated Booster Approved
  • 2022.09.12 WCHD to Begin Offering Bivalent Boosters.pdf
    document Header 2022.09.12 WCHD to Begin Offering Bivalent Boosters.pdf
  • 2022.09.19 WCHD High Dose Influenza Vaccine Available 9_20_22
    document Header 2022.09.19 WCHD High Dose Influenza Vaccine Available 9_20_22
  • 2022.09.23 WCHD Influenza Vaccine Available Today
    document Header 2022.09.23 WCHD Influenza Vaccine Available Today
  • 2022.10.26 IDPH News Release Halloween
    document Header 2022.10.26 IDPH News Release Halloween
  • 2022.10.27 Whiteside County Environmental Office Moves to Rock Falls Location
    document Header 2022.10.27 Whiteside County Environmental Office Moves to Rock Falls Location
  • 2023.05.02 Whiteside County CHC Mobile Physicals May and July
    document Header 2023.05.02 Whiteside County CHC Mobile Physicals May and July
  • 2023.05.11 WCHD & CHC Mark the End of the COVID-19 Public Health Emergency
    document Header 2023.05.11 WCHD & CHC Mark the End of the COVID-19 Public Health Emergency
  • 2023.06.15 West Nile Virus Reported in Four Illinois Counties so Far in 2023 as IDPH Warns Public to Fight the Bite.pdf
    document Header 2023.06.15 West Nile Virus Reported in Four Illinois Counties so Far in 2023 as IDPH Warns Public to Fight the Bite.pdf
  • 2023.08.24 Mosquitoes Test Positive for West Nile - Morrison IL
    document Header 2023.08.24 Mosquitoes Test Positive for West Nile - Morrison IL
    Mosquitoes collected on August 15, 2023 near Morrison, IL have tested positive for the West Nile virus according to Rian Nailor, Director of Environmental Health...

Immunizations2 documents

  • Immunization Consent Form
    document Header Immunization Consent Form
  • Immunization Fees
    document Header Immunization Fees
    Immunization Costs if Not Covered by Insurance

Environmental Documents63 documents

  • Environmental Health Fees.pdf
    document Header Environmental Health Fees.pdf

Body Art Program8 documents

  • Body Art Code.pdf
    document Header Body Art Code.pdf
  • Body Art Establishment Fee Structure.pdf
    document Header Body Art Establishment Fee Structure.pdf
  • Body Art Piercing Warning Posters.pdf
    document Header Body Art Piercing Warning Posters.pdf
  • Body Art Registration.pdf
    document Header Body Art Registration.pdf
  • Human Trafficking Poster.pdf
    document Header Human Trafficking Poster.pdf
  • Tattoo and Body Piercing Act.pdf
    document Header Tattoo and Body Piercing Act.pdf
  • What to know before getting a piercing.pdf
    document Header What to know before getting a piercing.pdf
  • What to konw before getting a tattoo.pdf
    document Header What to konw before getting a tattoo.pdf

Food Program20 documents

  • Consumer Advisory Sign Spanish.pdf
    document Header Consumer Advisory Sign Spanish.pdf
  • Cottage Food Home Self-Certification Checklist.pdf
    document Header Cottage Food Home Self-Certification Checklist.pdf
  • Cottage Food Registration Form.pdf
    document Header Cottage Food Registration Form.pdf
  • Food Allergy Awareness Notice.pdf
    document Header Food Allergy Awareness Notice.pdf
  • Food Date Labels.pdf
    document Header Food Date Labels.pdf
  • Food Establishment Plan Review and Application 2023.pdf
    document Header Food Establishment Plan Review and Application 2023.pdf
  • Food Safety Plan for Acidified and Fermented Foods.pdf
    document Header Food Safety Plan for Acidified and Fermented Foods.pdf
  • FOOD SERVICE SANITATION CODE.url
    document Header FOOD SERVICE SANITATION CODE.url
  • IDPH Consumer Advisory.pdf
    document Header IDPH Consumer Advisory.pdf
  • IDPH Cottage Food Guide 2022.pdf
    document Header IDPH Cottage Food Guide 2022.pdf
  • Lemonade Stand Application.pdf
    document Header Lemonade Stand Application.pdf
  • Mobile Unit Plan Review and Application.pdf
    document Header Mobile Unit Plan Review and Application.pdf
  • Plan Review Process Flow Chart.pdf
    document Header Plan Review Process Flow Chart.pdf
  • Procedure for the cleanup of vomit fecal event.pdf
    document Header Procedure for the cleanup of vomit fecal event.pdf
  • Temperature Log.pdf
    document Header Temperature Log.pdf
  • Temporary Event Permit.pdf
    document Header Temporary Event Permit.pdf
  • Temporary Food Guidelines.pdf
    document Header Temporary Food Guidelines.pdf
  • Websites for food worker cards.pdf
    document Header Websites for food worker cards.pdf
  • WHITESIDE COUNTY HEALTH CODE.url
    document Header WHITESIDE COUNTY HEALTH CODE.url
  • WHITESIDE COUNTY'S FOOD ESTABLISHMENT LOOK-UP.url
    document Header WHITESIDE COUNTY'S FOOD ESTABLISHMENT LOOK-UP.url

Private Sewage Program17 documents

  • Maintenance Agreement for Private Sewage Disposal System.pdf
    document Header Maintenance Agreement for Private Sewage Disposal System.pdf
  • Preparing for the Septic Evaluation.pdf
    document Header Preparing for the Septic Evaluation.pdf
  • Pumper Cleaner Corporate Form.pdf
    document Header Pumper Cleaner Corporate Form.pdf
  • Pumper Cleaner Individual Form.pdf
    document Header Pumper Cleaner Individual Form.pdf
  • Qualified Soil Investigation Services.pdf
    document Header Qualified Soil Investigation Services.pdf
  • Request for Septic Variance.pdf
    document Header Request for Septic Variance.pdf
  • Request to reuse septic and or well.pdf
    document Header Request to reuse septic and or well.pdf
  • Septic Application Non-Residential.pdf
    document Header Septic Application Non-Residential.pdf
  • Septic Application Private Residential.pdf
    document Header Septic Application Private Residential.pdf
  • Septic Cleaners-Pumpers Licensed In Whiteside County.pdf
    document Header Septic Cleaners-Pumpers Licensed In Whiteside County.pdf
  • Septic Elevation Form.pdf
    document Header Septic Elevation Form.pdf
  • Septic Installer Corporate Application.pdf
    document Header Septic Installer Corporate Application.pdf
  • Septic Installer Individual Application.pdf
    document Header Septic Installer Individual Application.pdf
  • Septic Installers Licensed in Whiteside County.pdf
    document Header Septic Installers Licensed in Whiteside County.pdf
  • Septic Undersized Lot Waiver Form.pdf
    document Header Septic Undersized Lot Waiver Form.pdf
  • Site Plan Instructions Septic.pdf
    document Header Site Plan Instructions Septic.pdf
  • Small Lot Plan Review.pdf
    document Header Small Lot Plan Review.pdf

Tanning Program4 documents

  • Tanning Act.pdf
    document Header Tanning Act.pdf
  • Tanning Application.pdf
    document Header Tanning Application.pdf
  • Tanning Code.pdf
    document Header Tanning Code.pdf
  • Tanning Warning Posters.pdf
    document Header Tanning Warning Posters.pdf

Water Well Program13 documents

  • Application for Permit to construct, modify or seal a closed loop well.pdf
    document Header Application for Permit to construct, modify or seal a closed loop well.pdf
  • Drilled Well Modification Completion Form.pdf
    document Header Drilled Well Modification Completion Form.pdf
  • Drilled Well Modification Completion Form.pdf
    document Header Drilled Well Modification Completion Form.pdf
  • Licensed Well Drillers Whiteside County.pdf
    document Header Licensed Well Drillers Whiteside County.pdf
  • Non Potable Water Well Compliance Agreement.pdf
    document Header Non Potable Water Well Compliance Agreement.pdf
  • Non-community Public Water System Application.pdf
    document Header Non-community Public Water System Application.pdf
  • Pump Installation Form.pdf
    document Header Pump Installation Form.pdf
  • Request for Well Variance Form.pdf
    document Header Request for Well Variance Form.pdf
  • Request to Reuse an Abandoned Well.pdf
    document Header Request to Reuse an Abandoned Well.pdf
  • Request to reuse septic and or well.pdf
    document Header Request to reuse septic and or well.pdf
  • Water well construction report.pdf
    document Header Water well construction report.pdf
  • Water Well Sealing Form.pdf
    document Header Water Well Sealing Form.pdf
  • Well Permit Application.pdf
    document Header Well Permit Application.pdf