Get Imm-5 Form - Nyc

The IMM-5 Form is essential for reporting information related to perinatal hepatitis B prevention in New York City. This guide will walk you through the process of filling out the form online, ensuring that you provide all necessary information accurately and efficiently.

Follow the steps to complete the IMM-5 Form online.

1. Press the ‘Get Form’ button to access and open the IMM-5 Form in your preferred editing environment.
2. In the 'Mother Information' section, provide the mother's name, address, and contact details. Ensure that you include the medical record number and the expected date of delivery.
3. Complete the 'Infant Information' section by entering the infant's name, date of birth, and birthing facility details, including weight or gestational age.
4. Fill out the 'Vaccination Information' with the timeline and details of vaccinations received by the infant including the vaccines administered, their brands, and their timing.
5. In the 'Reporter Information' section, include your name and title, the provider or facility name and address, and your contact information. Provide the report date to finalize this section.
6. Review all entries for accuracy before saving changes or sharing the form. Options may include downloading or printing the completed document for submission.

Start filling out your forms online today!