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Case Status Confirmed Probable CD RSS×New Jersey Department of Health Vaccine Preventable Disease Program PO Box 369, Trenton, NJ 086250369PERTUSSIS INVESTIGATION RECORDPossible Not a Case E×PATIENT

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How to fill out imm-24 njdohdot

01

To fill out imm-24 njdohdot, follow these steps:

02

Download the imm-24 njdohdot form from the official website of the New Jersey Department of Health.

03

Read the instructions carefully to understand the purpose and requirements of the form.

04

Provide your personal information accurately, including your full name, date of birth, and contact details.

05

Fill in the required details about your healthcare provider, such as their name, address, and phone number.

06

Specify the vaccine information, including the type of vaccine received, date of vaccination, and lot number if available.

07

If applicable, mention any adverse reactions experienced after the vaccination.

08

Sign and date the form to certify the accuracy of the information provided.

09

Submit the completed form to the appropriate authority as instructed.

Who needs imm-24 njdohdot?

01

Individuals who have received a COVID-19 vaccine in New Jersey and need to report their vaccination information are required to fill out imm-24 njdohdot.

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What is imm-24 njdohdot?

imm-24 njdohdot is a form required by the New Jersey Department of Health which must be filed by certain healthcare facilities.

Who is required to file imm-24 njdohdot?

Healthcare facilities such as hospitals, nursing homes, and clinics are required to file imm-24 njdohdot.

How to fill out imm-24 njdohdot?

imm-24 njdohdot can be filled out online or by mail following the instructions provided by the NJ Department of Health.

What is the purpose of imm-24 njdohdot?

The purpose of imm-24 njdohdot is to collect data on healthcare facilities and their services for regulatory and planning purposes.

What information must be reported on imm-24 njdohdot?

Information such as patient admissions, discharges, bed occupancy rates, and services provided must be reported on imm-24 njdohdot.

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