Get Mdph Vaccine Allocation Form

The Mdph Vaccine Allocation Form is an essential document for reporting influenza vaccine usage to the Massachusetts Department of Public Health. This guide provides clear, step-by-step instructions to help users fill out the form online effectively and accurately.

Follow the steps to complete the Mdph Vaccine Allocation Form online.

1. Click the ‘Get Form’ button to obtain the Mdph Vaccine Allocation Form and open it in your preferred online editor.
2. Enter your pin number in the designated field at the top of the form.
3. Fill in the date when you are completing the form.
4. Provide your provider site name and the contact person's name in the respective fields.
5. Insert the city or town where your provider site is located and the associated phone number.
6. Indicate the total number of doses received: include the total for 0.5 doses, 0.25 doses, and doses in the applicable sections.
7. In the section for reporting lost doses, use the box provided to list any doses lost and indicate the reason for the loss using the specified codes.
8. Complete the table detailing any doses given or received from another provider by circling whether these doses were received or redistributed, and fill in the relevant information.
9. Review all entered information for accuracy and completeness.
10. Once you have filled out the form, save your changes, and choose to download, print, or share the form as needed.

Complete your Mdph Vaccine Allocation Form online today to ensure accurate reporting and allocation!