The California Department of Public Health, Injury and Violence Prevention Branch (CDPH/IVPB), Domestic Violence Prevention Program intends to award contracts to the following agencies in response to Request for Application #23-10059, Strengthening Economic Security and Mobility as a Protective Factor for Domestic Violence Prevention … The Division of Communicable Disease Control (DCDC) works to promptly identify, prevent and control infectious diseases that pose a threat to public health, including emerging and re-emerging infectious diseases, vaccine-preventable agents, bacterial toxins, bioterrorism, and pandemics. DCDC branches also work closely with the Office of AIDS (a ... Find your local county office. Medi-Cal covers vital health care services for you and your family, including doctors visits, prescriptions, vaccinations, hospital visits, mental health care, and more. As COVID-19 becomes less of a threat, California will restart yearly Medicaid eligibility reviews using available information to decide if you or ... alzheimer’s disease program. Prevention. Research. Clinical. To improve the quality of life of aging Californians by promoting awareness of brain health and ADRD risk factors. To eliminate health disparities related to ADRD in California and improve health equity. To improve the quality of life for Californians living with ADRD. The mission of the California Department of Health Care Services (DHCS) is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental... Dec 21, 2023 · You can apply for Medi-Cal at any time of the year by mail, phone, fax, or email. You can also apply online or in person. Single Streamlined Application. Health Care Options (informed choices about Medi-Cal Managed Care) Managed Care Plans Directory (compare medical and dental plans in your county) e-Benefits California (Apply for Medi-Cal and ... The California Department of Public Health (CDPH) works to protect the public's health in the Golden State and helps shape positive health outcomes for individuals, families and communities. The Department's programs and services, implemented in collaboration with local health departments and state, federal and private partners, touch the lives ... Lyme disease may start as a mild illness that begins 3 to 30 days after a tick bite and might easily be mistaken for other common illnesses like a cold or flu. Signs and symptoms also can include a red, painless rash that may spread over time. If Lyme disease is not treated, it might develop into more severe health problems.The California Department of Public Health (CDPH) and the Centers for Disease Control and Prevention (CDC) develop guidance based on a broad range of available literature. This literature encompasses many face mask studies not included in the Cochrane review, ... Find your local county office. Medi-Cal covers vital health care services for you and your family, including doctors visits, prescriptions, vaccinations, hospital visits, mental health care, and more. As COVID-19 becomes less of a threat, California will restart yearly Medicaid eligibility reviews using available information to decide if you or ... Dec 21, 2023 · You can apply for Medi-Cal at any time of the year by mail, phone, fax, or email. You can also apply online or in person. Single Streamlined Application. Health Care Options (informed choices about Medi-Cal Managed Care) Managed Care Plans Directory (compare medical and dental plans in your county) e-Benefits California (Apply for Medi-Cal and ... Jan 30, 2024 · Isolate (stay home) until you have had no fever for 24 hours, without taking fever-reducing medication, AND your other symptoms are mild and improving. Wear a mask for the full 10 days*, even if you end isolation earlier (or until you have two sequential negative tests at least one day apart). Avoid contact with those who are at higher risk for ... September 23 , 2021 - Today, the California Department of Public Health (CDPH) released the most recent statistics on COVID-19 and updates on the state’s pandemic response. Joint Statement on FDA Authorization of Pfizer BioNTech Boosters.Rabies is a rare but serious disease caused by the rabies virus, which can infect the brains of both people and animals. Once people and animals are infected with the rabies virus, they almost always die. Each year in California, rabies is found in about 200 mostly wild animals. Rabies infects very few humans in the United States and California.Alaska ‘Pregnant Women Medicaid’ Changes Take Effect February 1. January 31, 2024, ANCHORAGE — In a significant step toward enhancing maternal healthcare access, the Alaska Department of Health (DOH) is implementing changes to … Training or Ex perience. Minimum one year of post-baccalaureate clinical training as a CLS. OR Minimum one year of work experience as a CLS performing high complexity testing in hematology, chemistry, blood bank, and microbiology. Training or work experience must be comprehensive to cover all areas of the clinical laboratory. Black Infant Health (BIH) Racism, as well as social and economic stressors, play a major role in poor birth outcomes—babies born too early and too small—for Black women. Within a culturally supportive environment, and honoring the unique history of Black women, California Black Infant Health (BIH) aims to help women have healthy babies.One in five people in the state receive health care services financed or organized by DHCS, making the department the largest health care purchaser in California. We invest more than $70 billion in public funds to provide health care services for low-income families, children, pregnant women, seniors, and persons with disabilities, while helping to maintain the health care …Today, the California Department of Public Health(CDPH) released the most recent statistics on COVID-19 and updates on the state's pandemic response. The most up to date data is available on the state's COVID-19 data dashboard. Cases, hospitalizations, and deaths are largely occurring among unvaccinated populations.The California Department of Public Health's mission is dedicated to optimizing the health and well-being of the people in California, and health-care clinicians and providers play a vital role. Here are several resource links that might be helpful. Please email [email protected] if you need help finding other resources on our CDPH web site.ADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4701) Explanation. You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. This form lets you do either or both of these things. It also lets you express your wishes regarding donation of ... Today, the California Department of Public Health(CDPH) released the most recent statistics on COVID-19 and updates on the state's pandemic response. The most up to date data is available on the state's COVID-19 data dashboard. Cases, hospitalizations, and deaths are largely occurring among unvaccinated populations. Xylazine is a central nervous system depressant that can cause drowsiness and amnesia and can also slow breathing, heart rate, and blood pressure to dangerously low levels. Taking opioids in combination with xylazine and other central nervous system depressants, like alcohol or benzodiazepines, increases the risk of life-threatening overdose.The goals of the CDPH Climate Change and Health Equity (CCHE) Branch 's CalBRACE Project are to enhance the State's capability to plan for and reduce health risks associated with climate change. The program provides resources and technical assistance for the state, local, and Tribal public health departments to build climate adaptation capacity ...Black Infant Health (BIH) Racism, as well as social and economic stressors, play a major role in poor birth outcomes—babies born too early and too small—for Black women. Within a culturally supportive environment, and honoring the unique history of Black women, California Black Infant Health (BIH) aims to help women have healthy babies.Data and Statistics. The Vital Records Data and Statistics cover a wide variety of health topics suitable for community health assessments, research for government and private studies, and public inquiry. Further, the programs within the Vital Records Data and Statistics include the Medical Marijuana Identification Card Program and the End of ...The California Department of Public Health is dedicated to optimizing the health and well-being of Californians en ... Let’s Get Healthy California Announces Local Innovations to Improve California’s Health; Dungeness Crab Health Advisory Lifted for Remainder of California Coast;a local county health department. Cottage foods must comply with food labeling requirements and additionally must state: “Made in a Home Kitchen” in 12-point type on the cottage food products’ Primary Display Panel (PDP). The registration or permit number of the “Class A” or “Class B” cottage food.The Genetic Disease Screening Program works to protect and improve the health of all Californians. We run the largest screening program in the world and set the standard in delivering high-quality, cost-effective genetic services to all Californians. Mission: To serve the people of California by reducing the emotional and financial burden of ...Covered California is a free service from the state of California that connects Californians with brand-name health insurance under the Patient Protection and Affordable Care Act. It’s the only place where you can get financial help when you buy health insurance from well …Jun 13, 2023 · Booster doses are available in many places, including healthcare providers, clinics and local pharmacies. Californians can visit the My Turn webpage (MyTurn.ca.gov) or call 833-422-4255, or visit Vaccines.gov to make an appointment or find a walk-in vaccine clinic near them. Originally published on March 2, 2022. The SWMHE is an annual exercise facilitated by CDPH and the California Emergency Medical Service Authority. The exercise scenarios align with the Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) grant requirements. SWMHE provides an opportunity to engage at the state level and meet exercise requirements.Xylazine is a central nervous system depressant that can cause drowsiness and amnesia and can also slow breathing, heart rate, and blood pressure to dangerously low levels. Taking opioids in combination with xylazine and other central nervous system depressants, like alcohol or benzodiazepines, increases the risk of life-threatening overdose.The California Department of Public Health - Vital Records (CDPH-VR) does not accept online orders. Customers wishing to use online order services may use independent, third party companies listed below, which will electronically transmit applications to CDPH-VR or a county vital records office for fulfillment.The TFP is issued only to licensed Physicians or Podiatrists in the form of a letter, and is verifiable at RHB's online TFP webpage. A person who holds a valid and current certificate, permit or TFP must display it, or a copy, at his or her worksite. It is the possession of a valid authorization, certificate, or permit that allows a person to ... We would like to show you a description here but the site won’t allow us. Obtain facility/provider information via the California Health Facilities Information Database (Cal Health Find) Learn about new health care requirements and/or guidance via All Facilities Letters. Access compliance information on State enforcement actions and penalties. Access license fee reports and licensing fee schedules. General Information. The mission of the California Department of Health Care Services (DHCS) is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental... The CDPH Infectious Diseases Branch (IDB) conducts surveillance, investigation, control, and prevention of many important infectious diseases in California, including botulism, coccidioidomycosis (Valley fever), foodborne, waterborne, vector-borne, zoonotic, and emerging infectious diseases. IDB activities are in four Sections:Lead is a toxic metal that has been used in many products over time. Even in small amounts, lead can have harmful effects on the body, which may lead to lifelong learning, behavioral, reproductive, cardiovascular, and other health problems. While many leaded products have been phased out, lead may still be found in and around older homes and ...The California Department of Public Health – Vital Records (CDPH-VR) can ONLY provide certified copies of certificates for public marriages that occurred in the years: 1905 to 1999. 2008 to 2022. 2000–2007, 2023. CDPH-VR is not able to provide certified copies of certificates for the years 2000 through 2007, and for 2023. Phone number: (916) 445-2684. Note: For death amendments related to the FEMA COVID Funeral Reimbursement Program, please use the following prompts: press 5 for amendments, press 2 for death, press 2 for deaths 2005 to present. Email: Obtaining certified copies of vital records: [email protected]. If you test positive for COVID-19, you should mask and speak with a doctor about treatment right away. If you also have symptoms of COVID-19, you should start isolation to protect others. On this page: Exposure recommendations Isolation recommendations Support during isolation Questions and answers Exposure …2 days ago · As of September 2010, query options for CNA, HHA and CHT have been updated to allow search by "last name starting with". Please note, when using this search option results may appear in large volume. In order to narrow the query results, we recommend search by "certificate/license number" or "last name, first name". (No query changes to NHA). Complete 40 hours of basic and advanced didactic (classroom) phlebotomy training from a phlebotomy program accredited by the California Department of Public Health. You must upload the certificate of completion during the online application process. Complete at least 40 hours of experience in a clinical setting in the last 5 years. You can get a link to your COVID-19 Vaccine Record with a QR code or your California Immunization Record. Save it on your phone and use it as proof of vaccination wherever you go. ... Department of Defense, Indian Health Services, or Veterans Affairs), you may need to contact those agencies for assistance with your vaccination record. If you ...The Genetic Disease Screening Program works to protect and improve the health of all Californians. We run the largest screening program in the world and set the standard in delivering high-quality, cost-effective genetic services to all Californians. Mission: To serve the people of California by reducing the emotional and financial burden of ...Welcome. Our dedicated staff works to prevent epidemics and the spread of disease, protect against environmental hazards, prevent injuries, promote and encourage healthy behaviors, respond to disasters and assist communities in recovery, and assure the quality and accessibility of health services throughout the County.Lyme disease may start as a mild illness that begins 3 to 30 days after a tick bite and might easily be mistaken for other common illnesses like a cold or flu. Signs and symptoms also can include a red, painless rash that may spread over time. If Lyme disease is not treated, it might develop into more severe health problems.CDPH/Health Alert - October 7, 2022 - The California Department of Public Health (CDPH), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), has been closely monitoring an outbreak of Ebola virus disease (EVD) due to Sudan virus (species Sudan ebolavirus) in Central Uganda.The Digital Vaccine Record (DVR) is a centralized electronic vaccination record from the California Immunization Registry (CAIR), which all Californians can access at their fingertips! Information in the DVR includes name, date of birth, vaccination dates, vaccines received, and future vaccine recommendations.Alaska ‘Pregnant Women Medicaid’ Changes Take Effect February 1. January 31, 2024, ANCHORAGE — In a significant step toward enhancing maternal healthcare access, the Alaska Department of Health (DOH) is implementing changes to …This document provides guidance to local health departments (LHDs) on COVID-19 outbreak reporting requirements and recommendations for non-healthcare settings. This includes recommendations for when facilities should report to LHDs (reporting thresholds), and outbreak definitions to determine when LHDs should report to California Department of ... We would like to show you a description here but the site won’t allow us. Jan 30, 2024 · Isolate (stay home) until you have had no fever for 24 hours, without taking fever-reducing medication, AND your other symptoms are mild and improving. Wear a mask for the full 10 days*, even if you end isolation earlier (or until you have two sequential negative tests at least one day apart). Avoid contact with those who are at higher risk for ... CDFA Animal Health and Food Safety Services, Animal Health Branch 1220 N Street Sacramento, California 95814 Phone: 916-900-5002 Fax: 916-900-5333 Email: [email protected] IVP Branch. Mailing Address. California Department of Public Health Injury and Violence Prevention (IVP) Branch PO Box 997377, MS 7214 Sacramento, CA 95899-7377. Physical Address. California Department of Public Health Injury and Violence Prevention (IVP) Branch 1616 Capitol Ave, Suite 74.436 MS 7214 Sacramento, CA 95814. Telephone (916) 552 …The Maternal, Child, and Adolescent Health (MCAH) Division works to improve the health and well-being of women, infants, children and adolescents throughout the state. Many programs and initiatives serve California’s diverse populations and regions, providing resources, information and data for physical, emotional, mental and social health.You can get a link to your COVID-19 Vaccine Record with a QR code or your California Immunization Record. Save it on your phone and use it as proof of vaccination wherever you go. ... Department of Defense, Indian Health Services, or Veterans Affairs), you may need to contact those agencies for assistance with your vaccination record. If you ... The Public Health Officer Order dated August 5, 2021, requires all workers who provide services or work in certain indoor long-term care settings (e.g., skilled nursing facilities, hospice facilities, PACE Centers, etc.) receive their first dose of a one-dose regimen or their second dose of a two-dose regime by September 30, 2021. Loan Repayments, Scholarships, & Grants. HCAI improves healthcare access by providing scholarships, loan repayments, and grants to students, graduates, and institutions providing direct patient care in areas of unmet need. Learn about the loan repayment programs, scholarships, grants, and more. The California Department of Public Health (CDPH) now recommends the following actions to align with common practice of other respiratory viruses. These actions outline what to do when an individual tests positive for COVID-19 and how to protect others, including the most vulnerable in the community. Find your local county office. Medi-Cal covers vital health care services for you and your family, including doctors visits, prescriptions, vaccinations, hospital visits, mental health care, and more. As COVID-19 becomes less of a threat, California will restart yearly Medicaid eligibility reviews using available information to decide if you or ... The California Department of Public Health (CDPH) works to protect the public's health in the Golden State and helps shape positive health outcomes for individuals, families and communities. The Department's programs and services, implemented in collaboration with local health departments and state, federal and private partners, touch the lives ... Certificates, Licenses, Permits, and registrations. CDPH's mission is optimizing the health and well-being of the people in California. This mission is achieved, in part, through the issuance of certificates, licenses, permits, and registrations. These authorizations assist in the regulatory oversight of professionals, facilities, and equipment. California Department Of Food And Agriculture Announces Vacancy on the Nursery Advisory Board. SACRAMENTO, March 25, 2024 — CDFA's Pest Exclusion Branch is announcing two vacancies on the Nursery Advisory Board. The board is composed of twelve voting members, each representing an establishment with a valid California …CDPH's mission is optimizing the health and well-being of the people in California. This mission is achieved, in part, through the issuance of certificates, licenses, permits, and … The Radiologic Health Branch (RHB) is within the Radiation Safety and Environmental Management Division of the Department of Public Health. The Branch enforces the laws and regulations addressing ionizing radiation, including radioactive material, designed to protect the public, radiation workers, and the environment. RHB is responsible for ... Jan 6, 2024 · Measles is a highly contagious viral disease. It is widespread in many parts of the world, including Europe, Africa, and Asia. Measles begins with a fever that lasts for a couple of days, followed by a cough, runny nose, conjunctivitis (pink eye), and a rash. The rash typically appears first on the face, along the hairline, and behind the ears ... A Report to the Legislature and the People of California by the Office of Health Equity. Sacramento, CA: California Department of Public Health, Office of Health Equity; February 2020. The Landscape of Opportunity: Cultivating Health Equity in California; California Pan-Ethnic Health Network; 2012. Methods and Concepts Related to Mortality Measures Certificates, Licenses, Permits, and registrations. CDPH's mission is optimizing the health and well-being of the people in California. This mission is achieved, in part, through the issuance of certificates, licenses, permits, and registrations. These authorizations assist in the regulatory oversight of professionals, facilities, and equipment. Public health laboratories, tissue banks, and blood banks . Get Started. Lab Resources & Other Information . Authorization to Order Clinical Lab Tests (PDF) CLIA Certificate Information. Clinical Lab Technology Advisory Committee (CLTAC) Lab and Personnel List Requests . Lab Emergency Information. The Division of Communicable Disease Control (DCDC) works to promptly identify, prevent and control infectious diseases that pose a threat to public health, including emerging and re-emerging infectious diseases, vaccine-preventable agents, bacterial toxins, bioterrorism, and pandemics. DCDC branches also work closely with the Office of AIDS (a ...The mission of the California Department of Health Care Services (DHCS) is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental...Jun 13, 2023 · Booster doses are available in many places, including healthcare providers, clinics and local pharmacies. Californians can visit the My Turn webpage (MyTurn.ca.gov) or call 833-422-4255, or visit Vaccines.gov to make an appointment or find a walk-in vaccine clinic near them. Originally published on March 2, 2022. The California Department of Public Health is dedicated to optimizing the health and well-being of Californians en ... Let’s Get Healthy California Announces Local Innovations to Improve California’s Health; Dungeness Crab Health Advisory Lifted for Remainder of California Coast;The Public Health Officer Order dated August 5, 2021, requires all workers who provide services or work in certain indoor long-term care settings (e.g., skilled nursing facilities, hospice facilities, PACE Centers, etc.) receive their first dose of a one-dose regimen or their second dose of a two-dose regime by September 30, 2021.This document provides guidance to local health departments (LHDs) on COVID-19 outbreak reporting requirements and recommendations for non-healthcare settings. This includes recommendations for when facilities should report to LHDs (reporting thresholds), and outbreak definitions to determine when LHDs should report to California Department of ...What is the California Department of Public Health (CDPH) doing about foodborne illnesses and outbreaks? Healthcare providers tell their local (county) health department about cases of foodborne illness, and in turn, local health departments tell CDPH so that public health officials can find and control outbreaks to prevent more people from ...While critics fear that CARE Court will become a new, easier pathway to conservatorship, Dr. Lisa Wong, the director of Los Angeles County’s Department of …Obtain facility/provider information via the California Health Facilities Information Database (Cal Health Find) Learn about new health care requirements and/or guidance via All Facilities Letters. Access compliance information on State enforcement actions and penalties. Access license fee reports and licensing fee schedules. General Information.The newly passed initiative builds on the Newsom Administration’s prior investments (here & here) and reforms (here & here), and will enable California to fully …If you test positive for COVID-19, you should mask and speak with a doctor about treatment right away. If you also have symptoms of COVID-19, you should start isolation to protect others. On this page: Exposure recommendations Isolation recommendations Support during isolation Questions and answers Exposure …
The California Department of Public Health – Vital Records (CDPH-VR) maintains a permanent, public record of every birth that has occurred in California since July 1905. Requesting a Certified Copy. Electronic Submission; Mail-In Request; VS 111 - Application to Obtain Certified Copy of Birth Record (PDF). We spa la
Feb 10, 2022 · Receive a call from a public health contact tracer. Receive a text message from one of California's notification tools, the Virtual Assistant. When you may need to follow different guidelines Your employer, school, place of residence, or local health department may have different recommendations or requirements. 2. Isola te . If you test positive, you are strongly encouraged to isolate (stay home and away from other people) for at least 5 full days, to prevent spreading the disease to others. Isolation is recommended even if you have been vaccinated or have had COVID-19 before. The End of Life Option Act allows an adult diagnosed with a terminal disease, who meets certain qualifications, to request the aid-in-dying drugs from their attending physician. The Act requires physicians to submit specified forms and information to the California Department of Public Health (CDPH). CDPH will collect data from forms submitted ... Xylazine is a central nervous system depressant that can cause drowsiness and amnesia and can also slow breathing, heart rate, and blood pressure to dangerously low levels. Taking opioids in combination with xylazine and other central nervous system depressants, like alcohol or benzodiazepines, increases the risk of life-threatening overdose. Today, the California Department of Public Health(CDPH) released the most recent statistics on COVID-19 and updates on the state's pandemic response. The most up to date data is available on the state's COVID-19 data dashboard. Cases, hospitalizations, and deaths are largely occurring among unvaccinated populations. COVID-19 County Check. Find hospital admission levels and prevention steps by county. Data updated weekly. The California Department of Public Health (CDPH) now recommends the following actions to align with common practice of other respiratory viruses. These actions outline what to do when an individual tests positive for COVID-19 and how to protect others, including the most vulnerable in the community. The mission of the California Department of Health Care Services (DHCS) is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental... To determine if you have TB germs in your body, your doctor may give you a blood test. The TB blood test is the recommended test for all individuals over the age of two. Your doctor will take a blood sample from your arm for testing and you will be able to know your test results within few days. For more information, please see the CDC Testing ...The California Department of Public Health – Vital Records (CDPH-VR) can ONLY provide certified copies of certificates for public marriages that occurred in the years: 1905 to 1999. 2008 to 2022. 2000–2007, 2023. CDPH-VR is not able to provide certified copies of certificates for the years 2000 through 2007, and for 2023.OA is a division within the California Department of Public Health, Center for Infectious Diseases. OA works collaboratively with state and federal agencies, local health jurisdictions, universities, and community-based organizations to ensure that efforts to combat the HIV/AIDS epidemic are targeted and effective.Black Infant Health (BIH) Racism, as well as social and economic stressors, play a major role in poor birth outcomes—babies born too early and too small—for Black women. Within a culturally supportive environment, and honoring the unique history of Black women, California Black Infant Health (BIH) aims to help women have healthy babies.Training. Your training must be obtained in a phlebotomy program accredited by the California Department of Public Health. There are three paths for training and experience, depending on the applicant’s on-the-job phlebotomy experience. For an applicant with no on-the-job phlebotomy experience or less than 40 hours of on-the-job phlebotomy experience:If you test positive for COVID-19, you should mask and speak with a doctor about treatment right away. If you also have symptoms of COVID-19, you should start isolation to protect others. On this page: Exposure recommendations Isolation recommendations Support during isolation Questions and answers Exposure …The Occupational Lead Poisoning Prevention Progra m (OLPPP) is a part of the California Department of Public Health's Occupational Health Branch. OLPPP provides services to prevent and reduce lead poisoning in California workplaces, including tracking blood lead levels in adults; investigating work-related lead poisoning cases; and providing ...The Digital Vaccine Record (DVR) is a centralized electronic vaccination record from the California Immunization Registry (CAIR), which all Californians can access at their fingertips! Information in the DVR includes name, date of birth, vaccination dates, vaccines received, and future vaccine recommendations.Volatile organic compounds (VOCs) are carbon containing chemicals that vaporize and can enter the body through normal breathing. VOCs can come from many sources. They are used as ingredients in paints, cleaning products, and adhesives. They are released by building materials such as carpet, linoleum, composite wood products, and insulation, to ...Yi 'Tom' Cai. 18111 Nordhoff Street, Northridge CA 91330-8320. Administrative Offices. Sequoia Hall 141. Phone: (818) 677-3051. Send email. Immerse yourself in the …Candida auris . Candida auris (C.auris) is a multidrug-resistant yeast that can spread in healthcare settings via person-to-person transmission or contact with contaminated surfaces. C. auris can cause serious, hard-to-treat infections. C. auris Case Counts .The California Department of Public Health - Vital Records (CDPH-VR) does not accept online orders. Customers wishing to use online order services may use independent, third party companies listed below, which will electronically transmit applications to CDPH-VR or a county vital records office for fulfillment..