Get Perinatal Hepatitis B Prevention Program Case Transfer Form - Cdc

Filling out the Perinatal Hepatitis B Prevention Program Case Transfer Form online is a crucial process for transferring case information between jurisdictions. This guide offers clear, step-by-step instructions to ensure that users can complete the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to access and open the form in the online editor.
2. Fill in the coordinator information section. Start by entering the jurisdiction where the case originated, including the city or state. Then provide the name, email, phone, and fax of the case manager or coordinator responsible in the originating jurisdiction.
3. Next, indicate the date of the transfer. This helps to keep accurate records of when the case was moved.
4. Enter the jurisdiction the case is moving to, including the relevant city or state. Again, provide the name, email, phone, and fax of the case manager or coordinator at the new jurisdiction.
5. Proceed to the case information section. Input the mother's name and the infant's name. Be sure to also include the infant's date of birth (DOB).
6. Provide the new phone number and address for the family, ensuring all contact information is accurate and up-to-date.
7. Include any case IDs associated with the transfer to help in tracking and managing the case effectively.
8. Finally, ensure that the coordinator receiving the new case confirms receipt. This can be done via fax, phone, or email. Document the confirmation date in the designated area.
9. Review the entire form for accuracy before final submission. Once confirmed, you can save changes, download, print, or share the form as needed.

Start completing your Perinatal Hepatitis B Prevention Program Case Transfer Form online today!