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IMMUNIZATION DOCUMENTATION FORM For All Credentialed Practitioners Type of Credentialing Application: Initial NOTE: Completion of this form is not required if you are ONLY applying to Behavioral Healthcare
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What is immunization documentation form?
Immunization documentation form is a form that records a person's immunization history, including vaccines received and dates.
Who is required to file immunization documentation form?
Individuals including children, students, employees, and healthcare workers are required to file immunization documentation form.
How to fill out immunization documentation form?
Immunization documentation form can be filled out by providing details of vaccines received, dates, and healthcare provider information.
What is the purpose of immunization documentation form?
The purpose of immunization documentation form is to track and record an individual's immunization history for health and safety purposes.
What information must be reported on immunization documentation form?
Information such as vaccines received, dates, healthcare provider information, and any medical exemptions must be reported on the immunization documentation form.
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