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Dr. Courtney N. Phillips
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Health Standards
Louisiana.gov > LDH > Health Standards Section
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forms to complete and submit to the health standards section

Enrollment Application

Attestation Statement

Crucial Data Extract

Health Insurance Benefit Agreement

Assurance of Compliance

Civil Rights Information Request

Social Security Act

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Mailing Address: Louisiana Department of Health | P. O. Box 629 | Baton Rouge, LA 70821-0629
Physical Address: 628 N. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568
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