Get Fl Dh1478 2019-2025

Filling out the FL DH1478 form, also known as the Florida SHOTS Notification and Opt-Out Form, is a vital process for individuals who choose not to participate in the Florida State Health Online Tracking System. This guide will walk you through the necessary steps to complete this form online, ensuring that you provide all required information accurately and efficiently.

Follow the steps to fill out the FL DH1478 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient's name in the provided fields. Make sure to fill in both the last and first names clearly.
3. Fill in the patient's date of birth using the format provided on the form. This is crucial for accurate record-keeping.
4. Input the patient's county of residence in the designated area.
5. While entering the patient's social security number is optional, you may do so if available for identification purposes.
6. Provide a contact phone number for the patient or the guardian. Ensure that the number is accurate as it may be used for follow-up communication.
7. If applicable, include the mother’s maiden name in the space provided, as this is also optional.
8. Indicate the sex of the patient by selecting the appropriate option. This section is optional as well.
9. If you have the state immunization ID number, please enter it in the relevant section.
10. The patient or legal guardian must sign the form. Ensure that the signer is at least 18 years old, as their signature is required for validation.
11. Print the name of the person signing the form underneath the signature field.
12. Review all entered information for accuracy. Once confirmed, you can save changes to the form, download, print, or share it as necessary.

Complete the FL DH1478 online today to ensure your opt-out request is processed efficiently.