
Provider Vaccine Inventory PIN / US IIS Udall State Supplied Vaccines Date SubmittedFacility Telephone with Area Foreperson Completing ReportVaccine Type DTaPDTaPHep BIPM (Pediatric)DTaPHIBIPV (Pentacle)Taping (INRI.
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How to fill out the UT VFC Provider Vaccine Inventory Form 7A online
The UT VFC Provider Vaccine Inventory Form 7A is an essential document for tracking and reporting vaccine inventory for providers. This guide will provide you with step-by-step instructions to complete the form efficiently and accurately.
Follow the steps to fill out the form online smoothly.
- Press the ‘Get Form’ button to access the document and open it in the editor.
- Begin by entering the VFC PIN or USIIS ID in the designated field at the top of the form.
- Fill in the date of submission to indicate when the form is being completed.
- Provide the facility name where the vaccines are administered.
- Include the phone number with the area code for easy communication.
- Specify the name of the person completing the report for identification purposes.
- In the vaccine type section, select the vaccine from the list provided, such as DTaP or Hepatitis A Pediatric.
- Record the manufacturer details for each vaccine listed.
- Input the lot number associated with each vaccine.
- Enter the NDC number that corresponds to the vaccines.
- Note the expiration date for each vaccine to ensure proper inventory management.
- Indicate the number of doses available for each vaccine listed.
- Calculate the grand total by summing the doses for each vaccine type and enter this in the Grand Total column.
- After completing all sections, save your changes, and consider downloading or printing a copy for your records.
- Finally, email a copy of the completed form along with your vaccine order to vacteam@utah.gov.
Complete the UT VFC Provider Vaccine Inventory Form 7A online today.
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