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Health & Human Services

  1. Adult Health Intake

    Public health intake form.

  2. Health Care Transportation Reimbursement Form

    Medical provider only completes this reimbursement form.

  3. Online: Children's mental health Respite Grant Application

    Online application for case managers to request respite

  4. Online: Child Protection Suspected Child Abuse/ Neglect Reporting Form

    Online form for reporting suspected child abuse/ neglect form

  1. Application for Appointment

    Please fill out an application for an appointment with the Itasca County Health and Human Services Advisory Committee.

  2. Medicare Redetermination Request Form
  3. Online: Adult Mental Health Case Management Referral Form

    Online form to submit referrals for adult mental health case management services.

  4. Online: Children's Mental Health Case Managment Referral Form

    Online form to submit referrals for children's mental health case management services.