Dhec 4024 form printable-2026

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The document is an application form for obtaining a license to provide midwifery services in South Carolina. It outlines the requirements and procedures for both initial and renewal licenses, including necessary documentation, personal information, and verification processes. The application must be completed under oath and submitted to the Division of Health Licensing.

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Click ‘Get Form’ to open the dhec 4024 form in the editor.
Begin by selecting the reason for your application in Line 1. Choose from options a, b, c, or d based on whether you are applying for an initial license or renewal.
In Line 2.a, enter your full name. For Line 2.b, provide your street address where you will conduct midwifery services.
If your mailing address differs from your service address, fill it in Line 2.c. Include both home and business phone numbers in Lines 2.d.
Complete Line 2.e with your date of birth and indicate your sex. In Line 2.f, add your email address if available.
Proceed to check all applicable boxes in Line 3 and provide any additional information requested.
Attach necessary documentation as specified in Lines 4 through 8 to support your application.
Finally, ensure that you sign the verification section at the end of the form before submitting it.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What counts as proof of immunization?

Photocopies of immunization records from a licensed healthcare provider or clinic, or from a California K-12 school uploaded to My Health Portal. All records must show the vaccine type, dose, and date of each shot.

Can I get a copy of my immunization records online on mychart?

Go to My Record Health Summary and select the Immunizations tab. You can see the immunizations youve received and the dates on which you received them. Click the immunization name to learn more. If your immunizations are not up to date, please docHub out to your clinic directly to have your information updated.

What is the quickest way to get immunization records?

The IIS only accepts medically verified vaccination dates into the system. Therefore, any CIS printed directly from the IIS is medically verified. No additional parent or health care provider signature is needed to verify the accuracy of the information. There are two versions of a CIS that prints from the IIS.

How to get a religious exemption for vaccines in SC?

How to Contact Your Jurisdictions IIS contact the IIS in your state or in the state where you or your child received their last shots to see if they have records. contact your immunization provider directly or your local or state immunization program through your states health department.

How do I get a certificate of immunization in SC?

To Find and Download a Vaccination Record: Go to the SIMON portal. Enter the patients information. Choose your relationship: Are you the parent, guardian, or self? Enter an email address. Click Search. Enter your verification code to see the patients immunization record or school certificate. Download your record.

dhec form 4024

SC DHEC immunization form SC Immunization form SC dhec Immunization Records South Carolina Immunization form for school DHEC form 2740 South Carolina Certificate of Immunization South Carolina Immunization Records online SC Immunization Schedule

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How do I get my SC immunization certificate?

How do I locate my immunization record? Visit the SIMON public portal to get your shot records, or contact your local health department or immunization provider. For help accessing your record using the SIMON public portal, click here.