Get the free Short-Dated Vaccine Report Form - dhss delaware
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Vaccines For Children Program Telephone: (800) 2828672 Fax: (302) 7419102ShortDated Vaccine Report Form Date Submitted: Provider Site: AFC PIN#: Provider Site Address: Contact: Telephone Number: Fax:
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How to fill out short-dated vaccine report form
How to fill out short-dated vaccine report form
01
To fill out a short-dated vaccine report form, follow these steps:
02
Start by entering the date of vaccination in the designated field.
03
Provide the name of the vaccine used.
04
Enter the lot number of the vaccine.
05
Indicate the expiration date of the vaccine.
06
Specify the patient's information, such as name, age, and medical history.
07
Include the healthcare professional's details, including their name and contact information.
08
Provide any additional relevant information or observations regarding the vaccination.
09
Review the form for accuracy and completeness before submitting it.
Who needs short-dated vaccine report form?
01
The short-dated vaccine report form is required for healthcare providers, clinics, and vaccination centers that administer vaccines, especially those with short expiration dates. It is necessary to monitor and track the usage and expiry of these vaccines to ensure patient safety and regulatory compliance.
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What is short-dated vaccine report form?
The short-dated vaccine report form is a document used to report vaccines that are approaching their expiration date.
Who is required to file short-dated vaccine report form?
Healthcare providers and facilities that store and administer vaccines are required to file the short-dated vaccine report form.
How to fill out short-dated vaccine report form?
The form typically requires information such as vaccine name, lot number, expiration date, quantity on hand, and storage conditions.
What is the purpose of short-dated vaccine report form?
The purpose of the short-dated vaccine report form is to ensure that vaccines are used before they expire and to help prevent vaccine wastage.
What information must be reported on short-dated vaccine report form?
Information such as vaccine name, lot number, expiration date, quantity on hand, and storage conditions must be reported on the short-dated vaccine report form.
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