Get Program Patient Eligibility Screening Record Form (dhec 1146) - Scdhec
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How to fill out the Program Patient Eligibility Screening Record Form (DHEC 1146) - Scdhec online
Completing the Program Patient Eligibility Screening Record Form (DHEC 1146) is essential for tracking children's eligibility for immunizations through the Vaccines for Children program. This guide provides clear, step-by-step instructions to help users accurately fill out the form online.
Follow the steps to successfully complete the eligibility screening record form.
- Press the ‘Get Form’ button to obtain the form and open it in your editable environment.
- In the first section, enter the child's full name, including their last name, first name, and middle initial.
- Fill in the child's date of birth in the specified format.
- Next, provide the name of the parent, guardian, or individual of record. Include last name, first name, and middle initial.
- Enter the name of the provider, again including last name, first name, and middle initial.
- For each immunization encounter, enter the date in the corresponding field and assess the child’s eligibility. Mark the appropriate eligibility category based on the options provided.
- Determine if the child is eligible for VFC vaccine by marking the appropriate column (A to D) or if they are not eligible (E to G).
- Review all entered information for accuracy before finalizing your form.
- After completing the form, you can choose to save your changes, download a copy, print the document, or share it as needed.
Complete your Program Patient Eligibility Screening Record Form online today to ensure accurate documentation and compliance.
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