Depression - Hawaii State Department of Health - Hawaii 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the 'Applicant Name' field. This identifies you as the scholarship applicant.
3. Next, fill in the 'Health Care Provider Name' and 'Hospital or Clinic Name' fields to provide details about your medical provider.
4. Complete the address section, including 'Street Address', 'City', 'Prov', and 'Postal Code' for accurate contact information.
5. Input the office telephone number and email of your health care provider to facilitate communication.
6. In the section for health care providers, ensure they summarize your medical history related to inflammatory bowel disease accurately.
7. The health care provider must select the appropriate diagnosis from Crohn’s disease, Ulcerative colitis, or another form of inflammatory bowel disease and sign with their credentials.

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