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Clear Form FORMD30 (2022×STATE OF HAWAII DEPARTMENT OF TAXATIONPERSONAL ASSESSMENT×LIABILITY QUESTIONNAIRE INSTRUCTIONS: Please complete all fields. If the field does not apply, write N×A. Attach
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It is a form required by the Hawaii Department of Health for reporting vaccine information.
Healthcare providers and institutions administering vaccines in Hawaii are required to file the form.
The form can be filled out electronically on the Hawaii Department of Health's website.
The purpose of the form is to track and monitor vaccine distribution and administration in Hawaii.
Information such as vaccine type, lot number, administration dates, and patient demographics must be reported.
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