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PUBLIC HEALTH NAME ADDRESS AND PERSONAL HISTORY (NASH) FORM (Revised 5/2012) Answer All Questions Below: Full Name of Person Picking up Medication: Address: City/State/Zip: Date of Birth: Phone: Date:
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How to fill out mass prophy - mahoninghealth
How to fill out mass prophy - mahoninghealth:
01
Obtain the mass prophy form from the mahoninghealth website or local health department.
02
Fill out your personal information accurately and completely, including your full name, address, date of birth, and contact information.
03
Provide any necessary additional information such as your insurance details, if required.
04
Indicate the type of prophy service you are seeking or the reason for the request.
05
Make sure to sign and date the form to validate your submission.
Who needs mass prophy - mahoninghealth:
01
Individuals who are seeking preventive healthcare services for the prevention and control of communicable diseases.
02
Those who reside in Mahoning County and need access to mass prophylaxis or mass vaccination during public health emergencies or disease outbreaks.
03
Any person who wants to proactively protect their health and well-being through immunization or other prophylactic measures administered by Mahoning County Health Department.
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What is mass prophy - mahoninghealth?
Mass prophy - mahoninghealth is a mass prophylaxis reporting system used by the Mahoning County Board of Health to track and monitor the distribution of medication or treatment during public health emergencies.
Who is required to file mass prophy - mahoninghealth?
Healthcare facilities, pharmacies, and other providers designated by the Mahoning County Board of Health are required to file mass prophy - mahoninghealth reports.
How to fill out mass prophy - mahoninghealth?
Providers can fill out mass prophy - mahoninghealth reports online through the designated reporting system provided by the Mahoning County Board of Health.
What is the purpose of mass prophy - mahoninghealth?
The purpose of mass prophy - mahoninghealth is to ensure timely and accurate reporting of medication or treatment distribution during public health emergencies.
What information must be reported on mass prophy - mahoninghealth?
Providers must report details of the medication or treatment distributed, the quantity distributed, the date and time of distribution, and the population served.
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