Consent to Treat for Immunizations

The Immunization Consent Form for Children and the HIPAA Consent Form must be completed by the parent or legal guardian if a friend or family member will be bringing your child for their immunization appointment with the Seneca County General Health District.

Immunization Consent Form for Children

HIPAA Consent Form - Internet

Send the completed forms, a current shot record and health insurance card(s) with the adult that is bringing your child to the appointment.

For all other nursing services (e.g. TB testing, lead testing, head lice check) please download and complete the following forms

Consent for Care and Release of Information

HIPAA Consent Form - Internet 

Send the completed forms and health insurance card(s) with the adult that is bringing your child.

Department Info

71 South Washington Street

Suite 1102

Tiffin, OH 44883

(419) 447-3691 ext. 333

Contact

Nursing Division

Seneca County General Health District

Suite 1102

Tiffin, OH 44883

Hours of Operation

Monday - Friday 

8:00 AM - 4:00 PM

© 2018 Seneca County General Health District 

71 South Washington St. Suite 1102 Tiffin, OH 44883

In the event of a public health emergency* the Seneca County General Health District can be contacted at anytime.

During regular business hours please call (419) 447-3691.

Regular business hours are Monday - Friday.

Nursing & Vital Statistics: 8:00 a.m. - 4:00 p.m.

Environmental: 8:00 a.m. - 4:30 p.m.

WIC: M-W 8:30 a.m. - 4:30 p.m., Thu. 8:30 a.m. - 7:00 p.m., Fri. 8:30 a.m. - 1:00 p.m.

After business hours, weekends, and holidays please contact the SCGHD Health Commissioner via the Seneca County Sheriff's Office at (419) 447-3456

 

*A public health emergency includes Class A reportable disease, foodborne illness, and bioterrorism event.  

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