Criminal History Record Check Forms Posted on HCS

Shelley Sabo in NYSCAL Notes

The NYSDOH has posted the following Criminal History Record Check forms on the HCS:

  • DOH CHRC Form 100 – Criminal History Record Check
  • DOH CHRC Form 101 - Authorized Person Designation Form And Notarized Sworn Statement
  • DOH CHRC Form 106 - Revocation Of Authorized Person Designation Form

The Forms can be found on the NYSCAL website at www.nyscal.org. We encourage providers to read all documents in their entirety.