Get Sd Doh Application For Authorization To Administer Influenza Immunizations 2013-2025

The SD DoH Application For Authorization To Administer Influenza Immunizations allows qualified pharmacists to apply for authorization to administer influenza immunizations. This guide provides clear, step-by-step instructions for completing the application online, ensuring you provide all necessary information accurately.

Follow the steps to successfully complete your application.

1. Click the 'Get Form' button to access the application. This will open the form in the editor for you to begin filling out.
2. Fill in your personal information, including your name, address, city, state, zip code, email address, and phone number, including the area code.
3. Enter your South Dakota pharmacist license number in the designated field.
4. Indicate whether this is a new application or a renewal application by checking the appropriate box.
5. If applying as a new applicant, attach a copy of your certificate of completion for an approved training program. Ensure that the training includes basic immunology, mechanics of immunity, administration processes, and relevant record-keeping requirements.
6. For new applications, also include a copy of your current cardio-pulmonary resuscitation training certificate, along with the date acquired.
7. For renewal applications, attach a copy of your certificate of completion for a minimum of two hours of continuing education related to immunizations.
8. For renewal applications, also include a copy of your current cardio-pulmonary resuscitation training certificate, along with the date acquired.
9. Affirm that the application is truthful and complete by signing and dating the application in the provided space.
10. Once all information is filled out and all attachments are included, you can save changes, download, print, or share the completed form as needed.

Complete your SD DoH Application for Authorization to Administer Influenza Immunizations online today.