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CONNECTICUT VACCINE PROGRAM VACCINE ORDER FORM (VOF)Clear FormPlease read the instructions on page 3 before completing and submitting this form Completed forms can be emailed to: dph.immunizations ct.gov.

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How to fill out the Connecticut vaccine program vaccine order form online

Filling out the Connecticut vaccine program vaccine order form (VOF) online can be a straightforward process if you follow the steps outlined in this guide. The VOF is essential for vaccine ordering and ensures that your facility receives the necessary supplies in a timely manner.

Follow the steps to complete your vaccine order form efficiently.

  1. Click ‘Get Form’ button to obtain the VOF and open it in your online form editor.
  2. Complete all identification and shipping information at the top of the form. This includes the facility name, shipping address, date of order, completed by section, your PIN, phone number, and the date range for doses administered.
  3. Indicate any dates during the month that your practice will be closed, ensuring you do not include weekends.
  4. Under the doses ordered column, enter the number of doses you need per vaccine product, rounding to the number of doses per pack listed on the VOF. It is advisable to order a minimum of four weeks' worth of supply.
  5. For each vaccine product, record the inventory details including the number of doses currently on hand, lot number, and expiration date, ensuring you do not duplicate lot numbers in your entries.
  6. Document the doses administered with state-supplied vaccines for the reporting month and year accurately.
  7. Review the completed form for accuracy before submission. Save changes to the document, ensuring to name it with your PIN and the title 'VOF'.
  8. Submit the completed form by clicking the submit button on page 1 or by attaching the saved form to an email addressed to dph.immunizations@ct.gov, or by faxing it to 860-706-5429.

Start filling out your vaccine order form online now to ensure timely processing of your vaccine orders.

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