Get Vaccine Requisition Form - Immunization Branch - Immunize Nc

The Vaccine Requisition Form is essential for requesting vaccines from the North Carolina Immunization Program. This guide will help you fill out the form accurately and efficiently to ensure your vaccine orders are processed without delay.

Follow the steps to complete the Vaccine Requisition Form online.

1. Press the ‘Get Form’ button to access the Vaccine Requisition Form. This will allow you to open the form in your preferred online editor for completion.
2. Begin filling out the facility name and the date at the top of the form. Ensure this information is accurate as it is essential for processing.
3. Indicate the refrigerator and freezer temperatures on the respective fields. Accurate temperature records are vital for ensuring vaccine efficacy.
4. Provide your contact information, including your name and any relevant extension number, for follow-up questions or clarifications.
5. Answer whether your facility will be closed in the next 30 days and provide the closure dates if applicable.
6. Fill out the federal identification number (FED ID #) and the shipping address to ensure proper delivery of requested vaccines.
7. List current vaccines available by entering the inventory data, including vaccine type, lot number, and expiration dates. This information must be accurate to avoid processing delays.
8. In the 'Doses Requested' section, calculate the number of doses needed by taking into account previous month doses, stock on hand, and adjusting for any potential closures.
9. Once all sections are completed and reviewed, save your changes to the document. You have the option to download, print, or share the form as needed.

Complete your Vaccine Requisition Form online today to ensure timely vaccine requests.