Local Health Officer Contact Information Update Form - 2015

Action Step B - To update your Local Health Officer Contact information, please complete all sections.

Check the box that applies to you:

Yes No      

* Official Letters of Appointment and other documents can be emailed to: judy.gopaul@maine.gov ; or by U.S. Mail to: Maine CDC, Division of Infectious Disease, 286 Water Street, 8th Floor, 11 SHS, Augusta, Maine 04333-0011, Attention: Judy Gopaul or by fax to: at 207-287-5355 Attention: Judy Gopaul. Maine CDC must receive notification of your appointment within 10 working days from your appointment. Important: Include a valid email address.

Mandatory Training:

Have you completed the LHO Core Training?

Are you a state employee?:

Are you employed by your town government in another role (other than the LHO)?:











    

Problems?

If you have any problems using this form, or do not receive a confirmation e-mail, contact Judy Gopaul