Get Chdp Program Letter 03-12. The Addition Of Pediarix Combination Vaccine (dtap, Hepatitis B And Ipv)

This guide will provide you with clear, step-by-step instructions on how to fill out the CHDP Program Letter 03-12 regarding the addition of the Pediarix combination vaccine. It aims to support users in effectively completing the form online and ensuring compliance with the necessary documentation requirements.

Follow the steps to complete the CHDP Program Letter 03-12 form online.

1. Click the ‘Get Form’ button to access and open the CHDP Program Letter 03-12 form in your preferred online editor.
2. Review the header of the form, ensuring it accurately states 'CHDP Program Letter No. 03-12' and the subject matter regarding the Pediarix vaccine.
3. Fill in the distribution information. Specify the county or city where the Provider Information Notice was sent and the date of distribution in the designated fields.
4. Complete the section for the program representative's name and title. Ensure the name is printed clearly for accurate identification.
5. Obtain the signature of the sender in the appropriate section, along with the date of signing, to validate the report.
6. Once all fields are completed, review the entire document for accuracy. Confirm that no revisions have been made to the Provider Information Notice.
7. Save the changes made to the form, and proceed to download or print the completed document as required.
8. Send the final version of the Report of Distribution to the specified address within 45 days of the original notice.

Complete your documentation process online today.