IN.gov - Skip Navigation

Note: This message is displayed if (1) your browser is not standards-compliant or (2) you have you disabled CSS. Read our Policies for more information.

Indiana State Department of Health

ISDH Home > Forms Forms

Communicable Disease

Fireworks Injury Reporting Form

Download the Fireworks Injury Reporting Form (State Form 51497) and either Fax or mail to the Indiana State Department of Health.

Fireworks Injury Reporting Form

Please fax this form to (317) 233-8199; Attn: Injury Prevention Epidemiologist
Or mail to: Indiana State Department of Health
2 North Meridian Street
Indianapolis, IN 46204
HIPAA

Immunization

Laboratories

          Review all the Clinical and Environmental

Medical Radiology

 

School Screening

Vital Records/Birth/Death Certificates

Adoption

Birth

Death

Indiana Clerk of Courts Documents

Marriage

Terminations

Confidential User Agreements