Get Vaccine Order Form - Ct.gov - Ct

Filling out the Vaccine Order Form is an essential process for healthcare providers to request vaccines. This guide provides clear and detailed instructions to help users complete the form effectively and submit it correctly.

Follow the steps to accurately complete your vaccine order form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter your facility name and the shipping address at the top of the form. Make sure this information is complete and accurate to ensure timely vaccine delivery.
3. Indicate any dates your practice will be closed during the month. Exclude weekends to ensure proper processing.
4. Balance your inventory from the last month's report to match your current physical inventory. Use the formula (inventory + order - doses administered) = actual inventory, making adjustments for any transfers and returns.
5. Calculate the number of doses needed and order at least a 5-week supply of each vaccine to avoid running out.
6. Report the total doses administered using whole numbers only. Ensure that this data reflects only state-supplied vaccines.
7. Record all expiration dates and lot numbers for the vaccines you are ordering. Keep this information organized, as it is crucial for tracking and compliance.
8. Review the completed form for accuracy before saving. Ensure that all sections are filled out according to the instructions provided.
9. Save the form as a PDF using your PIN number at the beginning of the file name (e.g., PIN 2000.VOF.pdf). Ensure you have a copy for your records.
10. Submit your completed VOF by either faxing it to 860-509-8371 or emailing it to dph.immunizations@ct.gov, ensuring you meet the deadline of the first business day of the month.

Start filling out your Vaccine Order Form online today to ensure timely vaccine access.