Get Ph 4023 Vaccine Transfer Request Form 10-10.doc

Completing the PH 4023 Vaccine Transfer Request Form 10-10.DOC is essential for effectively managing vaccine transfers between participants in the Vaccines for Children Program. This guide will provide you with clear, supportive instructions to help you fill out the form online with confidence.

Follow the steps to complete your vaccine transfer request form.

1. Press the ‘Get Form’ button to access the PH 4023 Vaccine Transfer Request Form 10-10.DOC and open it in your preferred editor.
2. In Section A, fill in the practice name and VFC PIN number. Ensure your contact name is clear, and provide the phone number where you can be reached.
3. Next, detail the vaccine and manufacturer information. Include the lot number, expiration date, and the number of doses being transferred. If needed, attach additional pages for more vaccines.
4. After completing Section A, the form must be faxed to the VFC Program at (615) 253-3279. This step is crucial as all transfers must be reported.
5. Section B will be completed by health department staff. They will document the date the regional health department was notified by the State VFC Program and verify that the vaccine is properly stored prior to transfer.
6. Once the vaccine transfer occurs, the transferring staff should fill in the date of vaccine transfer and their contact information.
7. In Section C, the recipient must complete the information, including practice name, VFC PIN number, contact name, and phone number. Identify if the vaccine received is identical to what is listed in Section A or if it differs, and provide the corresponding details.
8. After all sections are completed, save your changes, and ensure to download a copy of the completed form for your records. You may then print or share the document as necessary.

Begin filling out the PH 4023 Vaccine Transfer Request Form 10-10.DOC online today to ensure a smooth vaccine transfer process.