Get the free Illinois VFC Program 2012-2013 Seasonal Influenza Vaccine Order Form - idph state il

Este memorando establece las pautas y procedimientos para ordenar la vacuna contra la influenza para los pacientes elegibles para VFC en el estado de Illinois, incluyendo recordatorios sobre las recomendaciones

How to fill out illinois vfc program 2012-2013

How to fill out Illinois VFC Program 2012-2013 Seasonal Influenza Vaccine Order Form

1. Obtain the Illinois VFC Program 2012-2013 Seasonal Influenza Vaccine Order Form from the official website or your local health department.
2. Verify that your facility is eligible to order vaccines under the VFC Program.
3. Fill out the facility information section, including the facility name, address, and contact information.
4. Enter the order date and the total number of doses requested for each vaccine type.
5. Provide the number of doses previously ordered and received for each vaccine to avoid duplicates.
6. Check the appropriate boxes for the types of influenza vaccine you are requesting.
7. Include the signature of the person authorized to place the vaccine order, along with their title and date.
8. Review the form for accuracy and completeness before submission.
9. Submit the completed form to the designated state health department office or through the specified electronic submission method.

Who needs Illinois VFC Program 2012-2013 Seasonal Influenza Vaccine Order Form?

1. Healthcare providers enrolled in the Illinois Vaccines for Children (VFC) Program.
2. Medical practices that provide immunizations to eligible children under the age of 19.
3. Public health clinics and community health centers participating in the VFC Program.
4. Pharmacies that serve children and are part of the VFC Program.

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What is Illinois VFC Program 2012-2013 Seasonal Influenza Vaccine Order Form?

The Illinois VFC Program 2012-2013 Seasonal Influenza Vaccine Order Form is a document used by healthcare providers to order seasonal influenza vaccines for eligible children under the Vaccines for Children (VFC) program.

Who is required to file Illinois VFC Program 2012-2013 Seasonal Influenza Vaccine Order Form?

Healthcare providers who are enrolled in the VFC program and wish to receive seasonal influenza vaccines for their eligible patient population are required to file this form.

How to fill out Illinois VFC Program 2012-2013 Seasonal Influenza Vaccine Order Form?

To fill out the form, providers must include their practice information, select the type and quantity of vaccines needed, and ensure all required sections are completed accurately before submission.

What is the purpose of Illinois VFC Program 2012-2013 Seasonal Influenza Vaccine Order Form?

The purpose of the form is to facilitate the distribution of seasonal influenza vaccines to eligible children, ensuring access to immunization and improving public health outcomes.

What information must be reported on Illinois VFC Program 2012-2013 Seasonal Influenza Vaccine Order Form?

Providers must report their provider ID, shipping address, type of vaccine ordered, quantity requested, and any other relevant details as specified on the form.