Health Service Request Forms

Are you interested in BCHD coming to your event?

Please review the list of available programs and partners and their respective services listed below. Availability is based on staffing, date and target population. Form only acts as a notification to the appropriate programs to request their participation. Requests for health services must be submitted at least 15 days in advance but some programs need additional notice. Program participation is contingent upon staff availability and scheduling.

Download and complete the BCHD Health Service Request Form. Email the completed electronic PDF or any questions to camille.burke@baltimorecity.gov. NOTE: Pictures of completed forms will not be accepted.

Maternal & Child Health (MCH)

• MCH: Baltimore Infants & Toddlers – Health education and program materials; Giveaways
   
• MCH: Immunizations – Health education and program materials; COVAX information; COVAX Mobile Clinics; Limited Childhood immunization services
   
• MCH: Adolescent & Reproductive Health – Health education and program materials; Condoms

Chronic Disease Prevention (CDP)

• CDP: Tobacco Education & Cessation – Tobacco and smoking health education and program materials; Cessation classes; Workshops

Health Homes (HH)

• HH: Asthma – Health education and program materials; Home visiting information
   
• HH: Lead – Health education and program materials; Risk assessment information, Free Lead inspections; Cleaning kits and resources

Office of Youth & Trauma Services (YTS)

• YTS: Youth & Trauma Services – Health education and program materials

Div. Population Health & Disease Prevention

Population Health & Care Coordination (PHCC)

• PHCC: CharmCare – Health education and program materials; Social needs screenings; Referrals to city resources; Promotional items

Public Health Preparedness and Response (PHPR)

• PHPR: Preparedness & Response – Health education and program materials; Planning for Emergencies information; Presentations

Overdose Prevention (OP)

• OP: Youth Overdose Education (for schools and universities ONLY) – Health education and program materials; Culturally relevant education through art, music, and literature

Community Risk Reduction Services (CRRS)

• CRRS: Needle Exchange Van – Health education and program materials; Syringe service exchange
   
• CRRS: Harm Reduction Services – Health education and program materials; Overdose education; Narcan distribution; Naloxone Trainings

HIV/STI Prevention (HP)

• HP: HIV/STD Prevention – HIV and Syphilis testing; PrEP navigation; Linkages to care for HIV and Hep C; Referrals to community resources; Health literature; Condoms

Oral Health (OH)

• OH: Oral Health (need 3 week notice) – Health education and program materials; Dental supplies

Div. Aging & Care

Advocacy Services (AS)

• Maryland Access Point – Health education and program materials
   
• SHIP/SMP – Health education and program materials

Home and Community-Based Services (COS)

• Family Caregivers – Health education and program materials

Client Services (CLS)

• Guardianship – Health education and program materials

Other Direct Community Partners

• Social Services Foster & Adoption – Health education and program materials
   
• Office of Child & Family Success – Health education and program materials
   
• Civic Works – Health education and program materials; Youth jobs; Water 4 All Application assistance; Home Energy Program information; Elderly Services information
   
• Home Energy Program – Health education and program materials; Energy Program assistance
   
• Maryland Insurance Administration (need one month notice) – Insurance education and program materials; Presentations; Trainings
   
• MedStar Family Choice – Health education and program materials; Fitness band demonstrations; Giveaway
   
• Green & Healthy Homes Initiative - Lead poisoning, asthma, and injury prevention health education and program materials; comprehensive direct housing services