Get Vaccine Inventory Log Sheet
Date / Illinois VFC Pediatric Vaccine Order Inventory Accountability Form PIN Practice Name Phone Fax Report period start end Vaccine Delivery Street Address City ZIP Facility e-mail Mon Tues Wed Thurs Fri Office Days Hours Dates Office Closed next 30 days Fax Order to 217-786-7506 Form Revised 10/12/2011 Form Completed By Vaccine Doses on Hand Lot Number / Expiration Date Phone Physician s signature Wasted/Expired Vaccine Lot Num / Exp date Dose....
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