DOH Announces Update to CHRC Form DOH-102

The Department of Health (DOH) has issued a Dear Administrator Letter (DAL) to inform providers that the Acknowledgement and Consent for Fingerprinting and Disclosure of Criminal History Record Information form has been updated with a DOH form number. The updated form, labeled DOH-102, may be found on the Criminal History Record Check (CHRC) application under “Acknowledgement and Consent for Fingerprinting and Disclosure of Criminal History Record Information.” Translations are also available in Bengali, Chinese Simplified, Haitian Creole, Korean, Russian, and Spanish.

If you have questions regarding the revised form, please contact DOH via the “Contact CHRC” button in the top right-hand corner of the CHRC application for further clarification.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828