AL Public Health Imm 1481 2014 free printable template
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Vaccine CPT Code Unit Shipping Size Total Doses on NDC Doses Used Doses Requested since last order currently on contract Hand 10 x 1 dose vial Infanrix 90700 DTaP Daptacel 58160-0810-52 Expiration Date 10 x 1 dose syringes Lot Number 49281-0286-10 DTaP/HepB/IPV Pediarix 90698 DTaP-IPV/Hib 49281-0510-05 90696 DTaP-IPV 58160-0812-11 90702 90723 DT Havrix 90633 Hepatitis A Vaqta 6 x 1 dose Engerix B 90744 Hepatitis B Recombivax 00006...
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How to fill out AL Public Health Imm 1481
01
Begin by downloading the AL Public Health Imm 1481 form from the official website.
02
Use a black or blue pen to fill out the form; ensure that your handwriting is clear and legible.
03
In the 'Personal Information' section, fill in your full name, date of birth, address, and contact information.
04
Provide information regarding your health history, including any vaccinations you have received.
05
If applicable, include details about your travel history in the relevant sections.
06
Review the form for any errors or incomplete sections before signing.
07
Sign and date the form at the designated area.
08
Submit the completed form to your local public health department or as directed.
Who needs AL Public Health Imm 1481?
01
Individuals applying for a public health immunization record or vaccination verification.
02
Parents or guardians filling out vaccination records for their children.
03
Travelers who require proof of immunizations for international travel.
04
Residents needing to update or correct their immunization history.
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People Also Ask about
What age is CPT code 90698 for?
is billed with CPT-4 code 90698 (diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated [DTaP-Hib-IPV] for intramuscular use) and modifier SL, for use in individuals 6 months through 4 years of age (prior to 5th birthday).
What is NDC code 90675?
CPT® Code 90675 in section: Rabies vaccine.
What is NDC code 90700?
The Current Procedural Terminology (CPT®) code 90700 as maintained by American Medical Association, is a medical procedural code under the range - Vaccines, Toxoids.
What is the NDC code 90471?
Report codes 90471-90474 for immunization administration of any vaccine that is not accompanied by face-to-face physician or other qualified health care professional counseling the patient and/or family, or for patients over 18 years of age.
What is the NDC code 90698?
90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hemophilus influenza Type B, and poliovirus vaccine, inactivated (DTaP-HIB-IPV), for intramuscular use.
What is the NDC number for the DTaP vaccine?
Diphtheria and Tetanus Toxoids Adsorbed is supplied in: a 0.5 mL single-dose vial: NDC No. 49281-225-58; in packages of 10 vials: NDC No. 49281-225-10. The vial stopper is not made with natural
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What is AL Public Health Imm 1481?
AL Public Health Imm 1481 is a form used in Alabama for reporting certain immunization information to the public health authorities.
Who is required to file AL Public Health Imm 1481?
Individuals and organizations such as healthcare providers, schools, and child care facilities that administer vaccines are required to file AL Public Health Imm 1481.
How to fill out AL Public Health Imm 1481?
To fill out AL Public Health Imm 1481, provide accurate information regarding the immunization details, including patient information, type of vaccine administered, and the date of administration.
What is the purpose of AL Public Health Imm 1481?
The purpose of AL Public Health Imm 1481 is to ensure that immunization records are accurately reported and maintained for public health monitoring and vaccination tracking.
What information must be reported on AL Public Health Imm 1481?
The form must report the patient's name, date of birth, type of vaccine given, date of administration, and the provider's information.
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