517-335-8353 Immunization Christopher Smith V Barb Day 517-335-8333 734-240-7801 VI On-site Wastewater Treatment Dale Ladouceur Management 517-241-1348 Bob Barrie VII HIV/AIDs and Sexually 517-241-5934 Transmitted Disease Rachel Schumann VIII Vision 517-335-6596 Tory IX Breast and Cervical Cancer E.J. Siegl 517-335-8854 Control Program 517-335-8814 Barbara Derman dermanb@michigan.gov Sharon Karber 517-335-8696 X Family Planning 517-335-8910 Terri Riemenschneider Jean Egan 517-335-9562 XI Infants, and Children 517-241-6248 (WIC) Matt Richardson Courtney Pendleton 517-335-8994 XII Children’s Special Health Care 517-241-7189 Services (CSHCS) Sample Local Health Department On-site Review Exit Conference Form (Form is completed on the web-reporting module) I. Local Health Department Powers and Duties Conference Requested: Yes No LHD Representatives Included: II. Food Service Sanitation Program Conference Requested: Yes No LHD Representatives Included: III. General Communicable Disease Control Conference Requested: Yes No LHD Representatives Included: IV. Hearing Conference Requested: Yes No
V VI VII VIII IX X XI XII Immunization On-site Wastewater Treatment Management HIV/AIDs and Sexually Transmitted Disease Vision Breast and Cervical Cancer Control Program Family Planning Infants, and Children (WIC) Children’s Special Health Care Services (CSHCS) Christopher Smith Barb Day Dale Ladouceur Bob Barrie Rachel Schumann Tory E.J. Siegl Barbara Derman Sharon Karber Terri Riemenschneider Jean Egan Matt Richardson Courtney Pendleton 517-335-8353 517-335-8333 734-240-7801 517-241-1348 517-241-5934 517-335-6596 517-335-8854 517-335-8814 517-335-8696 517-335-8910 517-335-9562 517-241-6248 517-335-8994 517-241-7189 dermanb@michigan.gov Sample Local Health Department On-site Review Exit Conference Form (Form is completed on the web-reporting module) I. Local Health Department Powers and Duties Conference Requested: Yes No LHD Representatives Included: II. Food Service Sanitation Program Conference Requested: Yes No LHD Representatives Included: III. General Communicable Disease Control Conference Requested: Yes No LHD Representatives Included: IV. Hearing Conference Requested: Yes No
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