Get the free Vaccine Transfer Form - Washington State Department of Health

Vaccine Transfer Form INSTRUCTIONS Providers participating in the Adult Vaccine Program are required to request, receive approval, and report all vaccine transfers. To submit your request please email

How to fill out vaccine transfer form

How to fill out vaccine transfer form

1. Obtain the vaccine transfer form from the appropriate authority or organization.
2. Fill out all required personal information, such as name, date of birth, and contact information.
3. Indicate the specific vaccine(s) you wish to transfer and the reason for the transfer.
4. Provide any relevant medical history or information that may be necessary for the transfer
5. Sign and date the form as required.
6. Submit the completed form to the designated recipient or authority for processing.

Who needs vaccine transfer form?

1. Individuals who have received a vaccine but wish to transfer it to another person.
2. Healthcare professionals or organizations involved in vaccine distribution and administration.

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What is vaccine transfer form?

The vaccine transfer form is a document used to record the transfer of vaccines from one location to another.

Who is required to file vaccine transfer form?

Healthcare providers and facilities that are involved in the transfer of vaccines are required to file the vaccine transfer form.

How to fill out vaccine transfer form?

The vaccine transfer form should be filled out by providing all the necessary information about the transferred vaccines, including vaccine type, quantity, lot number, and expiration date.

What is the purpose of vaccine transfer form?

The purpose of the vaccine transfer form is to ensure accurate tracking and documentation of vaccine transfers to maintain proper inventory control and accountability.

What information must be reported on vaccine transfer form?

Information such as vaccine type, quantity, lot number, expiration date, transfer date, sender and receiver information must be reported on the vaccine transfer form.

What is the penalty for late filing of vaccine transfer form?

The penalty for late filing of the vaccine transfer form may include fines, sanctions, or other disciplinary actions depending on the regulations and policies in place.