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WebDOH Announces Update to CHRC Form DOH-102 The Department of Health (DOH) has issued a Dear Administrator Letter (DAL) to inform providers that the Acknowledgement and Consent for Fingerprinting and Disclosure of Criminal History Record Information form has been updated with a DOH form number. WebDOH CHRC 104 (9/06) NYS Department of Health EXPEDITED REVIEW REQUEST FORM FOR CRIMINAL HISTORY RECORD CHECK DOH use only. Leave Blank Type or print all information - USE CAPITAL LETTERS. Inaccurate, incomplete or illegible information will delay processing. SECTION 1 - SUBJECT INDIVIDUAL INFORMATION … WebDOH CHRC 102 (1/07) NYS Department of Health ... THIS FORM IS TO BE RETAINED BY THE AGENCY- DO NOT FORWARD TO THE DOH CHRC UNIT. [email protected] The purpose of this form is to obtain consent from the subject individual for fingerprints and criminal history record lamar advertising company wv