Region 5

Region 5


Alcona, Alpena, Antrim, Arenac, Benzie, Charlevoix, Cheboygan, Clare, Crawford, Emmet, Gladwin, Grand Traverse, Iosco, Isabella, Kalkaska, Lake, Leelanau, Manistee, Mason, Mecosta, Missaukee, Montmorency, Newaygo, Oceana, Ogemaw, Oscoda, Osceola, Otsego, Presque Isle, Roscommon, and Wexford Counties.

HELPDESK: 1-888-217-3904  –   Choose Option #1


MAIL USER AGREEMENTS & FORMS TO:
District Health Department #10
c/o Region 5 MCIR
3986 N. Oceana Drive
Hart,  MI 49420
Fax: 231-873-4366

Email:  region5mcir@dhd10.org

Please do not email modification forms or other protected health information.
These requests must be sent by fax or mailed to the address above.

Petition to Change Patient Information Form – Region 5 – Patient Information Correction

Petition to Change Immunizations Form – Region 5- Immunization Correction

Please fax completed forms to: 1-231-873-4366  *NEW FAX*

Contact


Amelia Peets
District Health Department #10
P.O. Box  850
White Cloud, MI 49349
Office:  231-355-7539
apeets@dhd10.org

Kimberly DePeel
District Health Department #10
3986 N. Oceana Drive
Hart, MI 49420
Office: 231-902-8538
kdepeel@dhd10.org 

5.20.2020