Get Dshs Form Ec 67
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How to fill out the Dshs Form Ec 67 online
The Dshs Form Ec 67, known as the Vaccine Transfer Authorization Form, is essential for managing vaccine transfers among providers in the Texas Vaccines for Children Program. This guide provides step-by-step instructions on how to accurately complete the form online, ensuring compliance with program regulations.
Follow the steps to successfully fill out the Dshs Form Ec 67 online.
- Click the ‘Get Form’ button to access the Vaccine Transfer Authorization Form and open it in your preferred online editor.
- Begin by filling in the 'Vaccine Transferring From' section. Provide the facility name, address, city, state, and zip code of the clinic transferring the vaccines.
- In the 'Reason for Transferring Request' section, check one of the appropriate options: overstock of vaccine, short dated vaccine, withdrawal from the TVFC Program, replenishing another clinic’s inventory, or other.
- Complete the 'Vaccine Transferring To' section by entering the facility name, address, city, state, zip code, phone, fax, and contact information of the receiving location.
- List each vaccine type on a separate row, including the National Drug Code (NDC), lot number, expiration date, and dose quantity for each vaccine being transferred.
- Review the certification statement at the end of the form. Ensure that you acknowledge the accuracy of the information provided and compliance with the TVFC Program requirements.
- After all sections are completed, save the changes, then download, print, or share the completed form as required.
Complete your Dshs Form Ec 67 online today to ensure compliance with vaccine transfer regulations.
Yes, vaccine transfer between TVFC ASN providers can be permitted when necessary to prevent shortages. This flexibility helps ensure that vaccines remain accessible to those in need, while still adhering to the guidelines set forth in the Dshs Form Ec 67. It's essential for providers to communicate effectively during these transfers to maintain accountability and compliance. For assistance with proper documentation, USLegalForms provides valuable tools to streamline the process.
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