Adult Immunization & Travel Clinic (AITC)
Pandemic Flu
Seasonal Flu
Chronic Viral Hepatitis Registry
Health Alerts
Vax Fax - Vaccine Updates
Report a Disease
Data & Publications
TB Services
HIV/AIDS Services
STD Services
Home
> Registration
Health Alert Notification Database (HAND)
Clinician Registration Form
The
HAND is a confidential database used only to send out important and timely health information.
Please check to be sure information has been entered into the required fields, then click ‘Submit’ below.
* = required field
*
First Name:
*
Last Name:
*
Phone, with Area Code:
*
Fax, with Area Code:
Title:
MD
DO
RN
NP
Other:
Organization Name:
Department:
*
Specialty:
Subspecialty:
*
Street address:
*
City:
*
ZIP Code:
Email address:
Pager nmber:
Cell phone number:
Health Alert receipt preferences:
Fax or
Email
Do you work in a:
Private Office or
Clinic
Its name:
If you are in a private practice, do you have another office:
(If ‘Yes’, please submit an additional Webform)
Yes or
No
Sometimes the Health Department sends out Health Alerts only to clinicians caring for certain type of patients. For example, last year an outbreak of wound botulism occurred in injection drug users. rather than sending a health Alert to all clincians, the Health Department sent the Alert only to the clincians taking care of injection drug users.
Does your patient population include:
Injection drug users:
Yes or
No
Homeless people:
Yes or
No
Homosexual clients:
Yes or
No
HIV infected patients:
Yes or
No
Have you received Helth Alerts in the past:
Yes or
No
Where there any problems:
Yes or
No
Are there other clinicians who work in your office/clinic:
Yes or
No
SF Dept of Public Health Home
|
SF City & County Home
© Copyright 1998 - 2006, Department of Public Health, City and County of San Francisco
Privacy Policy
|
Sitemap
|
Contact Us
