Contact Information
Los Angeles County
Department of Public Health
Office of Women's Health
1000 S. Fremont Ave.
Building A-9 East, Unit #105
Alhambra, CA 91803
Phone: (626) 293-2600
Email: owh@ph.lacounty.gov
DVHSS header

Invoices, Forms and Report Templates

Please note that for invoices, you must submit an e-signature. For instructions, please click here

Form Name Form Last released
Forms used by all contractors, regardless of contract
OWH_Form01 OWH Contract Contact Signature Authorization Form 10/2019
OWH_Form02 OWH Budget Form (FY19-20 only) 10/2019
OWH_Form03 OWH Financial Closeout Report 02/2020
OWH  Form04 Budget Modification Form 02/2020
Forms exclusively used for DVSBP Contractors
FY1920_DVSB_Form01 DVSBP Invoice 10/2019
FY1920_DVSB_Form02 DVSBP Annual Report 10/2019
Forms exclusively used for DVSS Contractors
FY1920_DVSS_Form01 DVSS Case Management Invoice 10/2019
FY1920_DVSS_Form02 DVSS Legal Services Invoice 10/2019
FY1920_DVSS_Form03 DVSS Substance Use Disorder (SUD) Invoice 10/2019
FY1920_DVSS_Form04 DVSS MMR - Case Management 10/2019
FY1920_DVSS_Form05 DVSS MMR -  Legal 10/2019
FY1920_DVSS_Form06 DVSS MMR - Substance Use Disorder (SUD) 10/2019
FY1920_DVSS_Form07 DVSS SUD Screener 10/2019
FY1920_DVSS_Form08 DVSS Event Services Form 10/2019
FY1920_DVSS_Form09 DVSS Customer Service Questionnaire 10/2019
FY1920_DVSS_Form010 DVSS Supplemental Invoice (FY19-20 only) 10/2019


Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.
Los Angeles County Seal: Enriching lives through effective and caring services