Registration Form

Learn about the Online Child and Adolescent Health Examination (CH205) Form, now available through the Citywide Immunization Registry (CIR) Online Registry.

New functions will allow you to enter all health examination data into an online form and then save, update and re-use these forms associated with your patients. This will save you time when you receive future requests for the CH205 from caregivers, by allowing you to easily retrieve a completed form and update it as necessary. The current CH205 form will still be available for use; however this form does not allow users to retrieve, change and submit completed forms. The Department strongly encourages you to use the new electronic version of the CH205 as it will assist you with time management and record retention and provide the Department with valued data. Completed forms can be submitted to the New York City Department of Health and Mental Hygiene electronically.

Below is a list of scheduled Webinar trainings aimed at helping you use the online CH205 Form.

If you have never taken a NYCDOHMH Webinar before, Please visit Webex to see how it works. Both internet access and a separate phone line are needed to participate. Registration is not required but would help us assess the need for additional sessions. Access per session is limited and on a first come basis. You need only to attend one session. The session will be about 30 minutes and the remainder of the time will be open for questions. See additional notes below.

       

Registration Information

*First Name:
*Last Name:
*Facility Name:
*CIR Facility Code:
VFC Pin
*Phone Number
Phone Extension (If applicable)
*E-mail Address
*Retype e-mail address to confirm

Online Child & Adolescent Health Examination (CH205) Form

Instructions:

 

To join the online meeting, you need both internet access and a separate phone line to participate.

1. Go to the video portion of the webinar by clicking the Meeting number.
2. If requested, enter your name and email address.
3. If a password is required, enter the meeting password provided below for each date.
4. Click "Join"
5. Dial 1-866-213-1863 for the audio portion of the webinar. When prompted enter the Access Code: 1960813. DO NOT place your line on “hold” while training is in session.
   

See important notes below.

Monday, August 27, 2012 Monday, August 27, 2012 - 12pm – 1pm Meeting Number: 753 698 579 Meeting password: Reg8-27

Tuesday, August 28, 2012 Tuesday, August 28, 2012- 12pm – 1pm Meeting Number: 751 037 097 Meeting password: Reg8-28

Thursday, August 30, 2012 Thursday, August 30, 2012- 12pm – 1pm Meeting Number: 756 473 984 Meeting password: Reg8-23

*Note:Sessions are open and are on a first come basis. If you call-in and you receive a message that the session is full, please choose another session at a later date or time. Please refer to the above instructions under each date.

*Note:You will need to enable JavaScript in your browser in order to submit this form. Please check whether you have the rich media players needed installed on your computer prior to the session by visiting Verify Rich Media Players page.

* Please enter the letters you see in the graphic below (required): (letters are not case-sensitive)

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