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DRAFTDEPARTMENT OF HEALTHBUREAU OF EMERGENCY MEDICAL OVERSIGHTAIR/GROUND SERVICE PROVIDER PERMIT APPLICATIONName of Service: ___EMS ID #: ___Business Address: ___ Business Phone: ___City: ___State:
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DH Form 631 is a document used by healthcare providers to report vaccine administration and related information to state health departments.
Healthcare providers who administer vaccines and want to report immunization data, particularly to state immunization registries, are required to file DH Form 631.
To fill out DH Form 631, gather patient immunization details such as dates of vaccine administration, vaccine type, and provider information. Complete the form accurately, ensuring all required fields are filled, and submit it according to your state's guidelines.
The purpose of DH Form 631 is to ensure accurate recording and reporting of immunization data to enhance public health surveillance and vaccination coverage.
Information that must be reported includes patient identifiers, vaccination dates, vaccine types, provider information, and any adverse effects noted.
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