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You are Here: Home Page > Library of Official Documents > Local Districts Social Service Forms  

Local Districts Social Service Forms

  • LDSS-3113 - Acknowledgement of Hysterectomy Information (PDF, 42KB, 1pg.)
  • LDSS-3113s - Acknowledgement of Hysterectomy Information (Spanish) (PDF, 27KB, 1pg.)
  • LDSS-3134 - Sterilization Consent Form (PDF, 85KB, 1pg.)
  • LDSS-3134s - Sterilization Consent Form (Spanish) (PDF, 122KB, 1pg.)
Questions or comments: medicaid@health.state.ny.us
Revised: May 2007
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