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Revised 2017-06-16 Name of client please print clearly Cochrane Kapuskasing 705-272-4996 705-337-1895 Hearst Matheson 705-362-7462 705-273-2522 Hib IPV Act-HIB / Polio Hornepayne Moosonee 807-868-2225 705-336-2919 Iroquois Falls Smooth Rock Falls 705-258-2249 705-338-2250 Other Please specify Result mm P Positive N Negative YY-MM-DD Date Test Read Recombivax Engerix B Varivax Varilrix 9 Proquad Priorix-Tetra Priorix MMR II Menjugate Pneumovax 23 Examples Influenza Rabies TB Skin Test...
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How to fill out immunization notification form branch
How to fill out immunization notification form branch
01
Gather all necessary information such as personal details, contact information, and immunization records.
02
Access the immunization notification form branch either in person or online.
03
Fill out the form by providing the required information accurately and legibly.
04
Ensure that all immunization dates and details are correctly entered.
05
Attach any supporting documents or proof of immunization as required.
06
Review the completed form for any errors or missing information.
07
Submit the form either by hand delivery or online submission.
08
Keep a copy of the submitted form for your records.
Who needs immunization notification form branch?
01
Parents or legal guardians of children who have received immunizations.
02
Healthcare providers or clinics administering immunizations to patients.
03
Schools or educational institutions requiring immunization records for enrollment.
04
Employers or organizations with immunization requirements for employees or members.
05
Individuals participating in certain activities or programs that mandate immunization.
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