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Porcupine Health Unit 169 Pine Street South Timmons, ONP HU Use Only Order No.:Healthcare Provider Requisition Form for Vaccines (TIMMONS ONLY)Tel: 7052671181Note: Please fax completed order along

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How to fill out influenza vaccine requisition form

01

Start by entering the name of the healthcare facility or organization at the top of the form.

02

Fill in the contact information including address, phone number, and email.

03

Indicate the quantity of influenza vaccines needed in the appropriate section.

04

Specify the type of influenza vaccine required (e.g. quadrivalent, high dose, etc).

05

Provide any additional information or special instructions in the designated area.

06

Review the completed form for accuracy and completeness before submitting.

Who needs influenza vaccine requisition form?

01

Healthcare facilities, clinics, pharmacies, and other providers who administer influenza vaccines need the influenza vaccine requisition form.

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What is influenza vaccine requisition form?

The influenza vaccine requisition form is a document used to request an order of influenza vaccines for a specific healthcare facility or organization.

Who is required to file influenza vaccine requisition form?

Healthcare facilities, clinics, hospitals, and other organizations that administer influenza vaccines are required to file the influenza vaccine requisition form.

How to fill out influenza vaccine requisition form?

To fill out the influenza vaccine requisition form, provide information about the facility, desired quantity of vaccines, delivery preferences, and contact details.

What is the purpose of influenza vaccine requisition form?

The purpose of the influenza vaccine requisition form is to ensure that healthcare facilities have an adequate supply of influenza vaccines to administer to patients.

What information must be reported on influenza vaccine requisition form?

Information such as facility name, address, contact person, desired quantity of vaccines, delivery preferences, and signature must be reported on the influenza vaccine requisition form.

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