Get Other Counties Immunization Data Report Form 108/108b - Azdhs

Filling out the Other Counties Immunization Data Report Form 108/108b is essential for compliance with immunization reporting requirements. This guide will provide you with clear, step-by-step instructions to successfully complete the form online.

Follow the steps to complete the immunization data report form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in all required fields at the top of the form, including the full name of your facility as shown in the sample report. Ensure accuracy to prevent any processing delays.
3. List children born on April 1, 2013, or later on separate pages from those born between October 1, 2009, and March 31, 2013, for clarity in reporting.
4. For each child born on or after October 1, 2009, provide their name and birthdate. Include children without immunization records to maintain comprehensive records.
5. Count the number of vaccine doses each child has received and record these numbers accurately on the report for each vaccine type.
6. If any child has a vaccine exemption, place an 'X' in the appropriate column indicating the type of exemption, such as permanent or temporary medical, or religious.
7. Before submitting, make copies of all completed forms for your records to ensure you have documentation of your submission.
8. Submit the completed form by mailing it to the ADHS Immunization Assessment Unit at the specified address by the deadline.
9. Review the submitted form for any errors and ensure it is postmarked by November 15 of the reporting year.

Complete your Other Counties Immunization Data Report Form online today for timely submission.