Get Chart Number Dob - Nyc

The Chart Number DOB - Nyc is an essential form for recording vaccination details for children and teens. This guide will provide a clear and structured approach to successfully completing the form online, ensuring that all necessary information is captured accurately.

Follow the steps to fill out the form online effectively.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering the patient's name in the designated field. Ensure the name is spelled correctly.
3. In the Chart Number field, provide the unique chart number associated with the patient.
4. For the DOB field, input the date of birth of the patient using the correct format.
5. Under the Vaccine section, select the type of vaccine administered, writing the generic abbreviation (e.g., DTaP, HepB) as specified.
6. Fill in the date given field with the exact date the vaccine was administered.
7. Indicate the funding source by selecting one of the options: F (Federally-supported), S (State-supported), or P (Private insurance or funds).
8. Provide the site of administration by designating whether it was the right arm, left arm, right thigh, or left thigh.
9. Record the lot number of the vaccine in the corresponding field.
10. Enter the expiration date of the vaccine.
11. Specify the vaccine manufacturer for the administered vaccine.
12. Document the date on the Vaccine Information Statement (VIS) that corresponds to the vaccine given.
13. Reconfirm the date given, ensuring it matches the date you previously entered.
14. Finally, have the vaccinator sign in the designated signature field.
15. Once the form is completed, you can save your changes, download a copy, print it, or share it as needed.

Take action now and fill out your documents online efficiently.