Get the free Vaccine ExpiredLoss Report - health ny

New York State Vaccines for Children Program (NYS AFC) Expired/Loss Report Provider Name: AFC PIN Address: Date: / / Month Day Year Contact Name: Phone #: Email Address: ALL PUBLICLYFUNDED VACCINE

How to fill out vaccine expiredloss report

How to fill out Vaccine Expired/Loss Report:

1. Begin by entering the date of the report, typically located at the top right corner of the form.
2. Provide the name of the vaccine manufacturer or supplier in the designated field. If the vaccine was obtained from multiple sources, specify each one separately.
3. Indicate the specific vaccine name or type that has expired or been lost. Include the lot number or any other unique identifiers, if available.
4. Input the expiration date of the vaccine that has expired or been lost. If the expiration date is unknown, contact the manufacturer or refer to the vaccine packaging for assistance.
5. State the quantity of the vaccine that has been expired or lost. This can be recorded in vials, doses, or any other measurement applicable to the specific vaccine.
6. Explain the reason behind the expiration or loss of the vaccine. Be concise and clear about the circumstances leading to the vaccine becoming unrecoverable or unusable.
7. Provide the name and contact information of the individual or entity responsible for the expired or lost vaccine. This may include the healthcare facility, distributor, or any personnel accountable for the vaccine's storage or handling.
8. Sign and date the form to verify its accuracy and authenticity.

Who needs Vaccine Expired/Loss Report:

1. Healthcare Facilities: Hospitals, clinics, and other medical institutions that administer vaccines need to maintain accurate records of expired or lost doses. This helps track inventory, identify trends, and ensure appropriate reporting to regulatory bodies.
2. Vaccine Suppliers/Distributors: Companies responsible for the distribution of vaccines are required to report any expired or lost doses to maintain transparency and facilitate appropriate reimbursements or replacements.
3. Regulatory Agencies: Government or public health authorities at local, state, or national levels often request vaccine expired/loss reports to monitor vaccine wastage, evaluate immunization coverage, and support overall vaccine management efforts.

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What is vaccine expiredloss report?

Vaccine expiredloss report is a report that documents any vaccines that have expired and are no longer usable.

Who is required to file vaccine expiredloss report?

Vaccine providers and facilities are required to file vaccine expiredloss report.

How to fill out vaccine expiredloss report?

To fill out vaccine expiredloss report, providers need to include information such as the type of vaccine, expiration date, quantity expired, and reason for expiration.

What is the purpose of vaccine expiredloss report?

The purpose of vaccine expiredloss report is to track and document expired vaccines to ensure proper inventory management and prevent the use of expired vaccines.

What information must be reported on vaccine expiredloss report?

Information that must be reported on vaccine expiredloss report includes the type of vaccine, expiration date, quantity expired, and reason for expiration.