Get Utah Department Of Health Community And Family Health Services Immunization / Usiis Program P O Box

This guide provides detailed instructions on how to fill out the Utah Department Of Health Community And Family Health Services Immunization / USIIS Program P O Box form online. It aims to support users in completing the form efficiently and accurately.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to initiate the process and access the form.
2. In the first section, enter the full name of the parent or guardian wishing to withdraw their child(ren) from USIIS. This should be printed clearly.
3. Complete the list of children by filling in the first, middle, and last names of each child on separate lines. Ensure all names are spelled correctly.
4. For each child, input their birth date in the format mm/dd/yyyy. Double-check to confirm the dates are accurate.
5. Provide the mother’s maiden name for each child, ensuring clarity and correctness.
6. Fill in the address section with the complete street address, including city, state, and zip code, without abbreviations.
7. The parent or guardian must sign in the designated area to authorize the withdrawal. Ensure the signature is clear.
8. Finally, enter the date of signing in the format mm/dd/yyyy.
9. Review all filled fields for accuracy and completeness before submission.
10. Submit the completed form by faxing it to the number provided or mailing it to the specified address.

Complete your documents online to ensure a smooth process.