This report is true and accurate. Please sign and date each page Signature of Operator/Owner North Carolina Department of Health and Human Services Division of Public Health Women s and Children s Health Section Immunization Branch 1917 Mail Service Center Raleigh NC 27699-1917 919-707-5550 Date Person Preparing Report DHHS 2900A Revised 08/11 Immunization Review 06/12 To provide child care operators with a means of fulfilling their legal obli.
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How to fill out the Dhhs 2900a online
The Dhhs 2900a is an essential form for child care facilities to report immunization records. This guide provides step-by-step instructions to help users complete the form accurately and submit it efficiently.
Follow the steps to fill out the Dhhs 2900a form online.
- Click the ‘Get Form’ button to obtain the Dhhs 2900a form and open it in your preferred editor.
- Complete the top portion of the form by entering your child care facility's name, phone number, street address, city, zip code, and county. Ensure that the information is accurate to avoid any processing delays.
- Provide your email address and the operator's name. Additionally, include the facility license number, which is crucial for official records.
- Indicate the total number of children enrolled at your facility and the total number of children without a shot record. This data helps maintain proper immunization tracking.
- For each child enrolled, fill in their first name, last name, and date of birth. Note that initials are not acceptable.
- If a child has a medical or religious exemption on file, mark 'yes' in the respective column. It is important to ensure these exemptions are documented correctly according to state law.
- Enter the total number of vaccine doses received by each child in the respective categories. Ensure all entries are factual to comply with reporting requirements.
- The last two vaccine sections (PCV7 and Hep A) are recommended but not required. If applicable, enter the number of doses or leave them blank if the child has not received these vaccines.
- The operator and the person preparing the report must sign and date each completed page of the form. Unsigned reports will be returned.
- Once completed, mail the white copy to the North Carolina Department of Health and Human Services and the yellow copy to your local health department. Keep the pink copy for your records.
- Finally, confirm that all information is accurate and complete before submitting the form.
Ensure compliance and keep children's immunization records updated by completing the Dhhs 2900a form online today.
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