Get Sc Dhec Form 1146

The Sc Dhec Form 1146 is essential for documenting the eligibility of children receiving immunizations under the Vaccines for Children (VFC) Program. This guide provides clear and supportive instructions for completing the form online to ensure compliance with eligibility screening requirements.

Follow the steps to complete the Sc Dhec Form 1146 online.

1. Click ‘Get Form’ button to access the Sc Dhec Form 1146 and open it in the editing tool.
2. Enter the child’s name, including last name, first name, and middle initial in the designated fields.
3. Fill in the child's date of birth using the format MM/DD/YYYY.
4. Input the parent, guardian, or individual of record's name, capturing last name, first name, and middle initial.
5. Complete the provider's name in the same format as above.
6. Record the date of the immunization visit. Decide the child's eligibility by marking the appropriate column(s) based on their insurance status.
7. Check the box in Column A (Medicaid Enrolled), Column B (No Health Insurance), Column C (American Indian or Alaska Native), Column D (Underinsured served by FQHC, RHC, or deputized provider) if eligible for VFC vaccine.
8. If the child is not eligible for VFC vaccine, mark Column E (Has health insurance that covers vaccines), Column F (State Underinsured), or Column G (Insured Hardship, Vaccine Caps).
9. Review all entered details for accuracy before finalizing the form.
10. Save the changes made to the form, and you will have options to download, print, or share the completed document.

Complete the Sc Dhec Form 1146 online today to ensure proper documentation for immunization eligibility.