Get Vaccine Return Form - Ct.gov - Ct

This guide provides clear, step-by-step instructions for completing the Vaccine Return Form. It is designed to assist users in navigating the form efficiently to ensure proper submission and processing.

Follow the steps to accurately complete the Vaccine Return Form.

1. Press the ‘Get Form’ button to access the Vaccine Return Form and open it for editing.
2. Fill in the facility name where the vaccine was stored. This identifies where the issue occurred.
3. Indicate the name of the person completing the form in the 'Completed By' section to ensure accountability.
4. Record the date of the report in the designated field to document when the return process was initiated.
5. Enter the lot number of the vaccine to help trace its origin in the reporting system.
6. Specify the number of doses affected by spoilage to quantify the loss.
7. Provide a contact phone number for follow-up communication regarding the return.
8. Include the expiration date(s) of the spoiled vaccine, ensuring proper handling and avoidance of expired products.
9. Attach a spoilage letter explaining the circumstances that led to the vaccine spoilage along with this form.
10. Select the vaccine brand and fill in the National Drug Code (NDC) number as these are essential for identification.
11. Once all fields are completed, save the changes to the form. Users can then download, print, or share the form as needed before submitting it by fax to 860-509-8371 or by email to DPH.Immunizations@ct.gov.

Complete your Vaccine Return Form online to ensure a smooth and efficient return process.