The below referral forms and programs are available to assist health care providers. Please call the St. Mary’s County Health Department at (301) 475-4330 during business hours for more information or guidance.
For urgent public health situations after business hours, please call the St. Mary’s County Emergency Operations Center at (301) 475-8016 to be connected to a public health official on-call.
Referral Forms for Department Services
- Report a Possible Animal Bite or Exposure (Note: Health care providers are required by state law to report animal bites or scratches) – Call the Health Department at (301) 475-4330 and submit Maryland State Form #4206 to the St. Mary’s County Health Department
- Disease Reporting – Call the SMC Health Department at (301) 475-4330 and submit Maryland State Form #1140 to the St. Mary’s County Health Department
- Chronic Disease Self-Management Program Referral Form
- Infants and Toddlers Program Referral Form
- Cancer Screening, Diagnosis, and Treatment (For eligible residents in need of breast, cervical, or colorectal cancer screening services)
- Resource Coordination Program (services to support individuals with disabilities))
- Prenatal Risk Assessment Form (For OB Providers to complete for pregnant women with active Medical Assistance. Fax to the SMCHD ACCU Program at 301-475-9431.)
- Local Health Service Request Form (For Providers and Community Partners to complete for Medical Assistance patients with barriers to accessing care, or if patient has questions/concerns regarding his or her Managed Care (MCO) or Medical Assistance benefits. Fax to the ACCU Program at 301-475-9431.)
- Postpartum Infant and Maternal Referral Form (For health dept assistance with very high risk infants and mothers)
- Asthma Control Program Home Visit (For children with asthma – free home visit for environmental trigger reduction and asthma education)