Get Viable Vaccine Transfer Form - Arizona Department Of ... - Azdhs

Filling out the Viable Vaccine Transfer Form is a crucial step in ensuring the proper transfer of vaccines between practices. This guide will walk you through the online process, providing clear and supportive instructions tailored to your needs.

Follow the steps to complete the form accurately and effectively.

1. Press the ‘Get Form’ button to obtain the form and access it in the designated editor.
2. Begin by entering the practice name in the designated field at the top of the form.
3. Input the Practice Identification Number (PIN) in the relevant field.
4. Fill in the name and PIN of the practice receiving the vaccine transfer.
5. Enter the address of the receiving practice in the appropriate section.
6. Provide the phone number of the practice that is receiving the transfer.
7. Include the fax number for the receiving practice, ensuring it is accurate for effective communication.
8. Designate a contact person at the receiving practice for any follow-up inquiries.
9. For each vaccine being transferred, indicate the vaccine name and select between vial (V) or syringe (S) in the respective fields.
10. Enter the lot number for each vaccine included in the transfer.
11. Input the expiration date for each vaccine to ensure compliance with safety standards.
12. Specify the total number of doses being transferred for each vaccine listed.
13. Ensure to sign the form in the designated section, indicating the person transferring the vaccines.
14. Have the receiving person sign the form in their respective section.
15. After completing the form, you can choose to save changes, download a copy, print it, or share it as needed.

Complete your Viable Vaccine Transfer Form online today to help ensure a smooth and efficient transfer process.