Get Public Health - Hepatitis B Vaccine Requisition Form - City Of Toronto

This guide provides you with clear instructions on how to complete the Public Health - Hepatitis B Vaccine Requisition Form for the City of Toronto online. By following the steps outlined below, you can ensure that your vaccine requisition is completed accurately and submitted efficiently.

Follow the steps to complete the form easily online.

1. Click the ‘Get Form’ button to obtain the form and open it in your browser or editor.
2. Begin by filling out the 'Vaccine ordered' section. Indicate whether the vaccine has been ordered or not.
3. In the 'Risk group' section, provide the necessary details about the individual's risk factors for hepatitis B.
4. Enter the patient's information, including last name, first name, birth date, and gender.
5. Complete the 'Case/Carrier Information' section, detailing the relationship of the patient to any carriers and any relevant health history.
6. In the 'Doctor to receive vaccine' section, provide the full name and address of the physician, clinic, or institution that will administer the vaccine.
7. Specify the number of doses being ordered, noting whether they are for pediatric or adult administration.
8. Fill in the contact information, including telephone and postal code, for both the ordering individual and the doctor.
9. Ensure you complete the 'OHIP Billing #' field, as this is required for processing the order.
10. Review all entered information for accuracy, then save your changes. You can download or print the completed form for your records or to fax to the Toronto Public Health.

Complete your Public Health - Hepatitis B Vaccine Requisition Form online today!